Department of Urology, Seoul National University Boramae Medical Center, Seoul, Korea.
Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
J Urol. 2018 Jun;199(6):1591-1599. doi: 10.1016/j.juro.2018.01.022. Epub 2018 Jan 9.
We compared long-term storage symptom outcomes between photoselective laser vaporization of the prostate with a 120 W high performance system and holmium laser enucleation of the prostate. We also determined factors influencing postoperative improvement of storage symptoms in the long term.
Included in our study were 266 men, including 165 treated with prostate photoselective laser vaporization using a 120 W high performance system and 101 treated with holmium laser enucleation of the prostate, on whom 60-month followup data were available. Outcomes were assessed serially 6, 12, 24, 36, 48 and 60 months postoperatively using the International Prostate Symptom Score, uroflowmetry and the serum prostate specific antigen level. Postoperative improvement in storage symptoms was defined as a 50% or greater reduction in the subtotal storage symptom score at each followup visit after surgery compared to baseline.
Improvements in frequency, urgency, nocturia, subtotal storage symptom scores and the quality of life index were maintained up to 60 months after photoselective laser vaporization or holmium laser enucleation of the prostate. There was no difference in the degree of improvement in storage symptoms or the percent of patients with postoperative improvement in storage symptoms between the 2 groups throughout the long-term followup. However, the holmium laser group showed greater improvement in voiding symptoms and quality of life than the laser vaporization group. On logistic regression analysis a higher baseline subtotal storage symptom score and a higher BOOI (Bladder Outlet Obstruction Index) were the factors influencing the improvement in storage symptoms 5 years after prostate photoselective laser vaporization or holmium laser enucleation.
Our serial followup data suggest that storage symptom improvement was maintained throughout the long-term postoperative period for prostate photoselective laser vaporization with a 120 W high performance system and holmium laser enucleation without any difference between the 2 surgeries. Also, more severe storage symptoms at baseline and a more severe BOOI predicted improved storage symptoms in the long term after each surgery.
我们比较了 120W 高性能系统的前列腺光选择性激光汽化术与钬激光前列腺剜除术治疗前列腺增生患者的长期储尿期症状的疗效。我们还确定了影响长期储尿期症状改善的因素。
本研究共纳入 266 例患者，其中 165 例行 120W 高性能系统前列腺光选择性激光汽化术治疗，101 例行钬激光前列腺剜除术治疗。所有患者均获得了 60 个月的随访数据。采用国际前列腺症状评分（IPSS）、尿流率和前列腺特异性抗原（PSA）评估患者术后 6、12、24、36、48 和 60 个月的疗效。术后储尿期症状改善定义为与术前基线相比，每次随访时总储尿期症状评分降低 50%或更多。
行前列腺光选择性激光汽化术或钬激光前列腺剜除术后，患者的频率、尿急、夜尿、总储尿期症状评分和生活质量指数改善可持续至 60 个月。在长期随访中，两组患者储尿期症状的改善程度和术后储尿期症状改善的患者比例均无差异。然而，与激光汽化组相比，激光剜除组患者的排尿症状和生活质量改善更为显著。多因素逻辑回归分析显示，术后 5 年时影响前列腺光选择性激光汽化术或钬激光前列腺剜除术后储尿期症状改善的因素为较高的基线总储尿期症状评分和较高的膀胱出口梗阻指数（BOOI）。
本研究的长期随访数据表明，120W 高性能系统的前列腺光选择性激光汽化术与钬激光前列腺剜除术均可在术后长期改善储尿期症状，且两种手术方式之间无差异。此外，基线时储尿期症状越严重、BOOI 越严重，两种手术方式的长期储尿期症状改善越显著。
