Sood Rajeev, Manasa T, Goel Hemant, Singh Ritesh Kumar, Singh Rajpal, Khattar Nikhil, Pandey Praveen
Departments of Urology and Anaesthesiology, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia (RML) Hospital, New Delhi, Delhi, India.
Arab J Urol. 2017 Oct 12;15(4):331-338. doi: 10.1016/j.aju.2017.06.004. eCollection 2017 Dec.
To conduct a prospective randomised study comparing the safety, effectiveness and treatment outcomes in patients undergoing bipolar transurethral resection of the prostate (bTURP) and photoselective vaporisation of the prostate (PVP) under sedoanalgesia, as sedoanalgesia is a safe and effective technique suitable for minimally invasive endourological procedures and although studies have confirmed that both TURP and PVP are feasible under sedoanalgesia there are none comparing the two.
Between November 2014 and April 2016, all patients satisfying the eligibility criteria underwent either bTURP or PVP under sedoanalgesia after randomisation. The groups were compared for functional outcomes, visual analogue scale (VAS) pain scores (range 0-10), perioperative variables and complications, with a follow-up of 3 months.
In all, 42 and 36 patients underwent bTURP and PVP under sedoanalgesia, respectively. The mean VAS pain score was <2 at any time during the procedure, with no conversions to general anaesthesia. PVP patients had a shorter operating time [mean (SD) 55.64 (12.8) vs 61.79 (14.2) min, = 0.035], shorter duration of hospitalisation [mean (SD) 14.58 (2.81) vs 19.21 (2.82) h, < 0.001] and a higher dysuria rate when compared to bTURP patients. However, the catheterisation time was similar and both intraoperative and postoperative complications were minimal and comparable. Improvements in the International Prostate Symptom Score, quality of life, prostate volume, maximum urinary flow rate and post-void residual urine volume at 3 months were similar in both groups. None of our patients required re-admission or re-operation.
Both PVP and bTURP can be carried out safely under sedoanalgesia with excellent treatment outcomes.
开展一项前瞻性随机研究，比较在清醒镇痛麻醉下接受双极经尿道前列腺切除术（bTURP）和前列腺光选择性汽化术（PVP）的患者的安全性、有效性和治疗结果。由于清醒镇痛麻醉是一种适用于微创腔内泌尿外科手术的安全有效技术，并且尽管研究已证实TURP和PVP在清醒镇痛麻醉下均可行，但尚无比较两者的研究。
2014年11月至2016年4月期间，所有符合入选标准的患者在随机分组后于清醒镇痛麻醉下接受bTURP或PVP。比较两组的功能结局、视觉模拟量表（VAS）疼痛评分（范围0 - 10）、围手术期变量和并发症，并进行3个月的随访。
共有42例和36例患者分别在清醒镇痛麻醉下接受了bTURP和PVP。术中任何时候的平均VAS疼痛评分均<2，无转为全身麻醉的情况。与bTURP患者相比，PVP患者的手术时间更短[平均（标准差）55.64（12.8）对61.79（14.2）分钟，P = 0.035]，住院时间更短[平均（标准差）14.58（2.81）对19.21（2.82）小时，P < 0.001]，尿痛发生率更高。然而，导尿时间相似，术中及术后并发症均很少且相当。两组在3个月时国际前列腺症状评分、生活质量、前列腺体积、最大尿流率和排尿后残余尿量的改善情况相似。我们的患者均无需再次入院或再次手术。
PVP和bTURP均可在清醒镇痛麻醉下安全进行，治疗效果良好。
