Pascoe Claire, Ow Darren, Perera Marlon, Woo Henry H, Jack Greg, Lawrentschuk Nathan
University of Melbourne, Department of Surgery, Austin Hospital, Melbourne, Australia.
Young Urology Researchers Organisation (YURO), Melbourne, Australia.
Transl Androl Urol. 2017 Jul;6(Suppl 2):S133-S141. doi: 10.21037/tau.2017.05.14.
Benign prostatic hyperplasia (BPH) is a common pathology causing lower urinary tract symptoms (LUTS) and may significantly impact quality of life. While transurethral resection of the prostate (TURP) remains the gold standard treatment, there are many evolving technologies that are gaining popularity. Photoselective vaporization of the prostate (PVP) is one such therapy which has been shown to be non-inferior to TURP. We aimed to review the literature and discuss factors to optimise patient outcomes in the setting of PVP for BPH. A comprehensive search of the electronic databases, including MEDLINE, Embase, Web of Science and The Cochrane Library was performed on articles published after the year 2000. After exclusion, a total of 38 papers were included for review. The evolution of higher powered device has enabled men with larger prostates and those on oral anticoagulation to undergo safely and successfully PVP. Despite continued oral anticoagulation in patients undergoing PVP, the risk of bleeding may be minimised with 5-Alpha Reductase Inhibitor (5-ARI) therapy however further studies are required. Pre-treatment with 5-ARI's does not hinder the procedure however more studies are required to demonstrate a reliable benefit. Current data suggests that success and complication rate is largely influenced by the experience of the operator. Post-operative erectile dysfunction is reported in patients with previously normal function following PVP, however those with a degree of erectile dysfunction pre-operatively may see improvement with alleviation of LUTS.
良性前列腺增生（BPH）是导致下尿路症状（LUTS）的常见病理状况，可能会对生活质量产生重大影响。虽然经尿道前列腺切除术（TURP）仍然是金标准治疗方法，但有许多不断发展的技术正越来越受欢迎。前列腺光选择性汽化术（PVP）就是这样一种已被证明不逊色于TURP的治疗方法。我们旨在回顾文献并讨论在BPH的PVP治疗中优化患者预后的因素。对包括MEDLINE、Embase、科学网和考科蓝图书馆在内的电子数据库进行了全面检索，以查找2000年后发表的文章。经过筛选，共纳入38篇论文进行综述。更高功率设备的发展使前列腺较大的男性以及正在接受口服抗凝治疗的男性能够安全、成功地接受PVP治疗。尽管接受PVP治疗的患者持续进行口服抗凝治疗，但使用5α还原酶抑制剂（5-ARI）治疗可将出血风险降至最低，不过还需要进一步研究。术前使用5-ARI进行预处理并不妨碍手术，但需要更多研究来证明其可靠的益处。目前的数据表明，成功率和并发症发生率在很大程度上受手术医生经验的影响。PVP术后，既往勃起功能正常的患者会出现勃起功能障碍的情况，然而术前有一定程度勃起功能障碍的患者，随着下尿路症状的缓解，勃起功能可能会有所改善。
