Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany.
Lasers Med Sci. 2019 Oct;34(8):1637-1643. doi: 10.1007/s10103-019-02760-1. Epub 2019 Mar 5.
The purpose of this prospective study of 90 consecutive patients is to assess the long-term durability of ThuVEP in patients with benign prostatic hyperplasia (BPH) and prostate volumes ≥ 85 ml. Ninety patients with prostates ≥ 85 ml underwent ThuVEP between 2008 and 2010 at our institution. Patient demographics and short-term and long-term follow-up were evaluated. Maximum urinary flow rate (Qmax), post-void residual urine (PVR), international prostate symptom score (IPSS), quality of life (QoL), complications, and PSA were assessed at follow-up. Median age at surgery was 71 (66-75.25) years. Thirty-seven (41.1%) of the patients were in urinary retention at the time of surgery. Prostate volume was 100 (88-122) ml. Median follow-up was 36.5 (16-60) months. At 12-month follow-up, IPSS, QoL, Qmax, and PVR had improved significantly compared with preoperative assessment and continued to do so during follow-up (p < 0.001). At 4-year postoperative, median Qmax (19.1 vs. 7.75 ml/s), PVR (31.9 vs. 150 ml), IPSS (4.5 vs. 24), and QoL (1 vs. 5) differed significantly from baseline (p ≤ 0.027). PSA decreased from 7.4 (4.14-14) to 0.70 (0.36-1.64) μg/l (p < 0.001) at 48-month follow-up, corresponding to a PSA reduction of 86.48% (79.85-95.25%). Urinary tract infections occurred in 2 (2.2%) patients. Urethral stricture and bladder neck contracture developed in 1 (1.1%) patient each. One patient (1.1%) had recurrent adenoma of the prostate and was treated with thulium vaporesection of the prostate. ThuVEP is a durable modern alternative to open prostatectomy for patients with substantially enlarged prostates due to BPH. The incidence of complications with ThuVEP during long-term follow-up was low.
这项前瞻性研究共纳入 90 例连续患者，旨在评估钬激光前列腺剜除术（ThuVEP）治疗良性前列腺增生（BPH）且前列腺体积≥85ml 患者的长期疗效。2008 年至 2010 年期间，我院对 90 例前列腺体积≥85ml 的患者实施了 ThuVEP。评估了患者的人口统计学特征以及短期和长期随访结果。在随访时评估最大尿流率（Qmax）、剩余尿量（PVR）、国际前列腺症状评分（IPSS）、生活质量（QoL）、并发症和 PSA。手术时的中位年龄为 71 岁（66-75.25 岁）。37 例（41.1%）患者在手术时存在尿潴留。前列腺体积为 100ml（88-122ml）。中位随访时间为 36.5 个月（16-60 个月）。在 12 个月随访时，与术前评估相比，IPSS、QoL、Qmax 和 PVR 均显著改善，且在随访过程中持续改善（p<0.001）。在术后 4 年时，中位 Qmax（19.1 比 7.75ml/s）、PVR（31.9 比 150ml）、IPSS（4.5 比 24）和 QoL（1 比 5）与基线相比差异有统计学意义（p≤0.027）。在 48 个月随访时，PSA 从 7.4μg/L（4.14-14μg/L）降至 0.70μg/L（0.36-1.64μg/L）（p<0.001），降幅为 86.48%（79.85-95.25%）。2 例（2.2%）患者发生尿路感染。1 例（1.1%）患者出现尿道狭窄，1 例（1.1%）患者出现膀胱颈挛缩。1 例（1.1%）患者前列腺再次发生腺瘤，行钬激光前列腺剜除术治疗。对于因 BPH 导致前列腺明显增大的患者，钬激光前列腺剜除术是一种替代开放性前列腺切除术的持久的现代治疗方法。在长期随访中，钬激光前列腺剜除术的并发症发生率较低。
