Cho Min Chul, Ha Seung Beom, Park Juhyun, Son Hwancheol, Oh Seung-June, Kim Soo Woong, Paick Jae-Seung
Department of Urology, Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
Department of Urology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Urology. 2016 May;91:158-66. doi: 10.1016/j.urology.2015.11.052. Epub 2016 Feb 12.
To evaluate impacts of preoperative detrusor underactivity (DU) on outcomes of photoselective vaporization of the prostate (PVP) or holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia, and to compare them between the two surgeries.
A total of 1423 men, who underwent PVP (group A) or HoLEP (group B), were categorized into four groups: A1 (239 without DU), A2 (432 with DU), B1 (329 without DU), and B2 (423 with DU). DU was defined as bladder contractility index of <100. Outcomes were assessed at 1, 3, 6, and 12 months postoperatively using International Prostate Symptom Score (IPSS), uroflowmetry, and prostate-specific antigen. Successful outcome was defined as reductions by ≥50% of total IPSS at 12 months postoperatively.
In all four groups, almost all parameters of IPSS and uroflowmetry improved starting from 1 month. A1 or B1 had greater increases in maximum flow rate than A2 or B2. Decreases of total IPSS in A2 were less than in A1 starting from 1 month after PVP, whereas those in B2 were less than those in B1 as late as 12 months after HoLEP. B2 showed greater improvements in maximum flow rate, subtotal voiding symptom score, bladder voiding efficiency, and total IPSS than A2. In all patients, multivariate regression analysis revealed that the absence of DU, presence of bladder outlet obstruction, and higher baseline total IPSS were independent predictors of successful outcome after surgery, but the type of laser surgery (PVP vs HoLEP) was not.
Our data suggest that micturition symptoms, maximum flow rate, bladder voiding efficiency, and quality of life improve starting from the early period after PVP or HoLEP, irrespective of DU. However, patients with DU may have less degree of improvement in micturition after PVP or HoLEP than those without DU.
评估术前逼尿肌活动低下（DU）对良性前列腺增生患者接受前列腺光选择性汽化术（PVP）或钬激光前列腺剜除术（HoLEP）手术效果的影响，并比较这两种手术的效果。
共有1423名接受PVP（A组）或HoLEP（B组）手术的男性患者被分为四组：A1组（239例无DU）、A2组（432例有DU）、B1组（329例无DU）和B2组（423例有DU）。DU定义为膀胱收缩力指数<100。术后1、3、6和12个月使用国际前列腺症状评分（IPSS）、尿流率测定和前列腺特异性抗原评估手术效果。成功的手术效果定义为术后12个月时总IPSS降低≥50%。
在所有四组中，从术后1个月开始，IPSS和尿流率测定的几乎所有参数均有所改善。A1组或B1组的最大尿流率增加幅度大于A2组或B2组。PVP术后1个月起，A2组总IPSS的下降幅度小于A1组，而HoLEP术后12个月时，B2组总IPSS的下降幅度仍小于B1组。B2组的最大尿流率、排尿症状总分、膀胱排尿效率和总IPSS的改善程度均大于A2组。在所有患者中，多因素回归分析显示，无DU、存在膀胱出口梗阻以及较高的基线总IPSS是术后手术成功的独立预测因素，但激光手术类型（PVP与HoLEP）不是。
我们的数据表明，无论是否存在DU，PVP或HoLEP术后早期，排尿症状、最大尿流率、膀胱排尿效率和生活质量均有所改善。然而，与无DU的患者相比，有DU的患者在PVP或HoLEP术后排尿改善程度可能较小。
