1 Department of Urology, ASL02 Abruzzo , Chieti, Italy .
2 Department of Urology, University "G. d'Annunzio" , Chieti, Italy .
J Endourol. 2018 Nov;32(11):1071-1077. doi: 10.1089/end.2018.0437. Epub 2018 Oct 20.
To assess the extent to which surgical experience can affect perioperative and functional outcomes after photoselective vaporization of the prostate (PVP) with 180W XPX GreenLight laser in patients with lower urinary tract symptoms secondary to benign prostatic obstruction (BPO).
Data from 291 consecutive patients with symptomatic BPO (median follow-up 12 m) were collected and analyzed. Patients were treated at 2 different institutions by 2 expert (G1, n = 182) and 2 novice (G2, n = 109) transurethral prostate surgeons (February 2013 - March 2017) and underwent standard or anatomical PVP depending on surgeons' preferences. Patients' characteristics, perioperative and functional outcomes were compared using the chi-square and Mann-Whitney U tests. Patients' satisfaction was measured using the Patient Global Impression of Improvement (PGI-I) score. Learning curves were analyzed based on changes in quantitative parameters: surgery time, lasing/operative time, and energy delivered (kJ).
Patients' baseline characteristics, perioperative data and PGI-I score were similar. Overall the complication rates showed better trends for G1. Serum prostate-specific antigen levels, maximum flow rate, and International Prostatic Symptoms Score improved in both groups, with perceived improvements greater in G2 (p < 0.006). Lasing time/operative time ratio showed greater evolution for G1 than G2 (0.50:IQR 0.38-0.60 vs 0.46:IQR 0.34-0.58, respectively)(p = 0.201). A major increase in energy delivery for G2 was achieved within the first 50 procedures, whereas more than 100 iterations were needed for G1 to reach LT/OT >60%.
Surgeons' background and expertise appear to affect outcomes over the learning curve, with roughly similar perioperative and functional results.
评估手术经验在经尿道前列腺 180W XPX 绿激光前列腺选择性汽化术（PVP）治疗下尿路症状继发于良性前列腺梗阻（BPO）患者中的围手术期和功能结果中的影响程度。
收集并分析了 291 例有症状 BPO 患者（中位随访时间 12 个月）的数据。这些患者由 2 位经验丰富的（G1，n=182）和 2 位新手（G2，n=109）经尿道前列腺外科医生在 2 家不同的机构治疗，根据外科医生的偏好进行标准或解剖性 PVP。使用卡方和曼-惠特尼 U 检验比较患者特征、围手术期和功能结果。使用患者总体印象改善（PGI-I）评分来衡量患者的满意度。根据手术时间、激光/手术时间和输送能量（kJ）的变化来分析学习曲线。
患者的基线特征、围手术期数据和 PGI-I 评分相似。总体而言，G1 的并发症发生率呈现出更好的趋势。两组患者的血清前列腺特异性抗原水平、最大尿流率和国际前列腺症状评分均有所改善，G2 患者的改善程度更大（p<0.006）。G1 的激光时间/手术时间比值的演变大于 G2（0.50：IQR 0.38-0.60 与 0.46：IQR 0.34-0.58，p=0.201）。G2 在 50 例手术内就实现了能量输送的大幅增加，而 G1 则需要超过 100 次迭代才能使 LT/OT>60%。
外科医生的背景和专业知识似乎会影响学习曲线期间的结果，围手术期和功能结果大致相似。
