Department of Urology, University of Montreal Hospital Center (CHUM), Montréal, QC, Canada.
Department of Urology, CHU Tours, Tours, France.
World J Urol. 2017 Oct;35(10):1603-1609. doi: 10.1007/s00345-017-2007-7. Epub 2017 Feb 22.
To evaluate the outcomes and durability of photoselective vaporization of the prostate (PVP) using the XPS-180 system in patients with a large prostate volume (PV) > 100 cc at 4 years of follow-up in a large, multicenter experience.
438 men with pre-operative transrectal ultrasound (TRUS) PV > 100 cc were treated in eight experienced centers in Canada, USA, and in France with the Greenlight XPS laser using PVP for the treatment of symptomatic BPH. IPSS, Qmax, postvoid residual (PVR), and prostate-specific antigen (PSA) were measured at 6, 12, 24, 36, and 48 months. Durability was evaluated using BPH retreatment rate at 12, 24, and 36 months.
Median PV and PSA were 121 cc and 6.3 ng/dl. Indwelling catheter at the time of surgery was observed in 37% of men. Median operative, laser time, and energy applied were 90 min, 55 min, and 422 kJ, respectively. Median energy delivery was 3.4 kJ/cc of prostate per case. Outpatient surgery was feasible with median length of stay at 24 h. IPSS, Qmax and PVR were significantly improved at all endpoints including at 48 months. Moreover, surgical BPH retreatment rates were 5.4 and 9.3% at 24 and 36 months. Interestingly, characteristics of retreated men include: energy delivery 2.4 vs. 3.4 kJ/cc of prostate (p = 0.02) and PSA reduction at 12 months 26 vs. 51% (p = 0.02).
PVP using Greenlight XPS-180W can potentially provide durable improvements with regard to functional outcomes at 4 years. However, rising retreatment rates after 3 years is of concern. This highlights the imperative need of utilizing a standardized surgical technique (enucleation-like-defect) and an optimal energy density >3KJ/cc.
在一项大型多中心经验中，评估使用 XPS-180 系统对前列腺体积（PV）>100cc 的患者进行选择性光汽化前列腺切除术（PVP）的结果和耐久性，随访时间为 4 年。
在加拿大、美国和法国的 8 个经验丰富的中心，使用 Greenlight XPS 激光对 438 名术前经直肠超声（TRUS）PV>100cc 的男性患者进行治疗，采用 PVP 治疗有症状的 BPH。在 6、12、24、36 和 48 个月时测量国际前列腺症状评分（IPSS）、最大尿流率（Qmax）、残余尿量（PVR）和前列腺特异性抗原（PSA）。在 12、24 和 36 个月时，使用 BPH 再治疗率评估耐久性。
中位 PV 和 PSA 分别为 121cc 和 6.3ng/dl。术中留置导尿管的患者占 37%。手术的中位操作时间、激光时间和应用能量分别为 90 分钟、55 分钟和 422kJ。每例前列腺的中位能量输送量为 3.4kJ/cc。可行门诊手术，中位住院时间为 24 小时。在所有终点，包括 48 个月时，IPSS、Qmax 和 PVR 均显著改善。此外，24 个月和 36 个月时的手术 BPH 再治疗率分别为 5.4%和 9.3%。有趣的是，再治疗男性的特征包括：能量输送量 2.4 与 3.4kJ/cc 的前列腺（p=0.02）和 PSA 降低 12 个月后分别为 26%与 51%（p=0.02）。
使用 Greenlight XPS-180W 的 PVP 可能在 4 年内提供关于功能结果的持久改善。然而，3 年后再治疗率上升令人担忧。这凸显了采用标准化手术技术（类似剜除的缺损）和优化能量密度>3KJ/cc 的必要性。
