Section of Urology, Department of Surgery, University of Montreal Hospital Center, Université de Montréal, Montreal, Quebec, Canada.
Department of Urology, Clinique Pasteur Toulouse, Toulouse, France.
J Urol. 2015 Aug;194(2):462-9. doi: 10.1016/j.juro.2015.03.113. Epub 2015 Apr 4.
We evaluated photoselective vaporization of the prostate using the GreenLight™ XPS™ 180 W system for benign prostatic hyperplasia treatment in a large multi-institutional cohort at 2 years. We particularly examined safety, outcomes and the re-treatment rate in larger prostates, defined as a prostate volume of 80 cc or greater, to assess the potential of photoselective vaporization of the prostate as a size independent procedure.
A total of 1,196 patients were treated at 6 international centers in Canada, the United States, France and England. All parameters were collected retrospectively, including complications, I-PSS, maximum urinary flow rate, post-void residual urine, prostate volume, prostate specific antigen and the endoscopic re-intervention rate. Subgroup stratified comparative analysis was performed according to preoperative prostate volume less than 80 vs 80 cc or greater on transrectal ultrasound.
Median prostate size was 50 cc in 387 patients and 108 cc in 741 in the prostate volume groups less than 80 and 80 cc or greater, respectively. The rate of conversion to transurethral prostate resection was significantly higher in the 80 cc or greater group than in the less than 80 cc group (8.4% vs 0.6%, p <0.01). I-PSS, quality of life score, maximum urinary flow rate and post-void residual urine were significantly improved compared to baseline at 6, 12 and 24 months of followup without significant differences between the prostate size groups. The re-treatment rate at 2 years reported in 5 of 411 patients was associated with the delivery of decreased energy density (2.1 vs 4.4 kJ/cc) in the group without re-treatment.
Photoselective vaporization of the prostate using the XPS 180 W system is safe and efficacious, providing durable improvement in functional outcomes at 2 years independent of prostate size when treated with sufficient energy.
我们评估了使用 GreenLight™ XPS™ 180 W 系统对良性前列腺增生进行的前列腺光选择性汽化治疗，该研究为在 6 个国际中心（加拿大、美国、法国和英国）的大型多机构队列中进行的 2 年研究。我们特别检查了安全性、结果和较大前列腺（定义为前列腺体积为 80cc 或更大）的再治疗率，以评估前列腺光选择性汽化作为一种与体积无关的手术的潜力。
共有 1196 例患者在 6 个国际中心接受了治疗。所有参数均为回顾性收集，包括并发症、I-PSS、最大尿流率、残余尿量、前列腺体积、前列腺特异性抗原和内镜再干预率。根据经直肠超声检查术前前列腺体积<80 与 80cc 或更大，进行亚组分层比较分析。
387 例患者的前列腺中位数为 50cc，741 例患者的前列腺中位数为 108cc，分别在前列腺体积<80 和 80cc 或更大的组中。80cc 或更大组中转行经尿道前列腺切除术的比例明显高于<80cc 组（8.4%比 0.6%，p<0.01）。与基线相比，I-PSS、生活质量评分、最大尿流率和残余尿量在 6、12 和 24 个月的随访中均显著改善，两组之间无显著差异。在 411 例中有 5 例需要再次治疗的患者中，在未再次治疗的患者中，能量密度降低（2.1 比 4.4kJ/cc）与再次治疗率相关。
使用 XPS 180 W 系统的前列腺光选择性汽化是安全有效的，当使用足够的能量治疗时，在 2 年内可提供持久的功能改善，与前列腺大小无关。
