Rapisarda Sebastiano, Russo Giorgio I, Osman Nadir I, Chapple Christopher R, Morgia Giuseppe, Tubaro Andrea, Esperto Francesco
Unit of Urology, Department of Surgery, University of Catania, Catania, Italy.
Unit of Urology, Department of Surgery, University of Catania, Catania, Italy -
Minerva Urol Nefrol. 2019 Dec;71(6):569-575. doi: 10.23736/S0393-2249.19.03350-2. Epub 2019 Apr 5.
In the last decade therapeutic options for patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement (BPE) have constantly increased. Although transurethral resection of the prostate (TURP) is still considered the surgical gold standard, different lasers and advanced techniques have been introduced as alternatives to TURP.
A non-systematic Medline/Pubmed literature search was performed with different combination of terms including: "BPH," "M-TURP," "B-TURP" "bladder outlet obstruction," "YAG laser," "Diode laser," "Potassium titanyl phosphate," "KTP," "bladder outlet obstruction" (BOO), "BOO in small prostate". Only studies reporting prostate volume ≤40 cc were considered for this review.
Current evidence on the use of laser as a therapeutic modality as compared to TURP reported similar functional results of bipolar-TURP, Thulium laser and Greenlight. For prostate gland ≤40 cc, HoLEP can be technically more difficult while Holmium-TUIP seems to be a valid option but with a higher rate of retrograde ejaculation which is considerably higher than the rate in electrocautery series. The diode laser showed excellent intra-operatively haemostasis with clear endoscopic vision and durable improvements in functional results, but may produce greater passive thermal energy conduction that can cause scrotal edema and anal pain. However, conclusions need to be drawn after median to long term evaluation of patients and consideration of the economic implications, coupled with the potential for reducing morbidity.
Evidence acquisition from the literature showed that mini-invasive surgeries, including Greenlight laser and Holmium laser incision represent valid alternatives to TURP in prostate ≤40 g. We reported effective results of laser therapy as therapeutic modalities as compared to TURP for the small prostate ≤40 mL, both for enucleation and excision or cauterization, however cost effective of laser in the current literature are still scarce and it should be implemented.
在过去十年中，继发于良性前列腺增生（BPE）的下尿路症状（LUTS）患者的治疗选择不断增加。尽管经尿道前列腺切除术（TURP）仍被视为手术金标准，但不同的激光和先进技术已被引入作为TURP的替代方案。
使用包括“BPH”“M-TURP”“B-TURP”“膀胱出口梗阻”“YAG激光”“二极管激光”“磷酸钛氧钾”“KTP”“膀胱出口梗阻”（BOO）“小前列腺中的BOO”等不同术语组合在Medline/Pubmed进行了非系统性文献检索。本综述仅纳入报告前列腺体积≤40 cc的研究。
与TURP相比，目前关于使用激光作为治疗方式的证据表明，双极TURP、铥激光和绿激光的功能结果相似。对于≤40 cc的前列腺，holmium激光前列腺剜除术（HoLEP）在技术上可能更困难，并钬激光经尿道前列腺切开术（Holmium-TUIP）似乎是一个有效的选择，但逆行射精发生率较高，明显高于电灼系列的发生率。二极管激光在术中显示出出色的止血效果，内镜视野清晰，功能结果持久改善，但可能产生更大的被动热能传导，从而导致阴囊水肿和肛门疼痛。然而，需要在对患者进行中长期评估并考虑经济影响以及降低发病率的可能性之后得出结论。
文献中的证据表明，对于≤40 g的前列腺，包括绿激光和钬激光切开术在内的微创手术是TURP的有效替代方案。我们报告了与TURP相比，对于≤40 mL的小前列腺，无论是剜除、切除还是烧灼，激光治疗作为治疗方式的有效结果，然而目前文献中激光的成本效益仍然缺乏，应该加以实施。
