Reimann Maximilian, Fishman Nikita, Lichy Isabel, Wiemer Laura, Hofbauer Sebastian, Almedom Zenai, Buckendahl John, Steiner Ursula, Schlomm Thorsten, Friedersdorff Frank, Cash Hannes
Department of Urology, Charité-University Medicine Berlin, 12203 Berlin, Germany.
J Clin Med. 2019 Jul 10;8(7):1004. doi: 10.3390/jcm8071004.
The aim of this paper was to compare the perioperative and postoperative results of photoselective vaporization of the prostate with the GreenLight-XPS 180 Watt System (PVP) and transurethral resection of the prostate (TURP). This retrospective study included 140 men who underwent PVP and 114 men who underwent TURP for symptomatic benign prostate enlargement (BPE) between June 2010 and February 2015. The primary outcome measures were the patient reported outcome, operative results, International Prostate Symptom Score-Quality of Life (IPSS-QoL), complication rates, catheterization time, and length of hospital stay. The median follow-up times were 27 months (range 14-44) for the PVP group and 36 months (range 25-47) for the TURP group. The patient characteristics were well balanced in both groups with a median age of 71 years (PVP group) vs. 70 years (TURP group) and a comparable prostate volume (median 50 mL in the PVP group vs. 45 mL in the TURP group). The IPSS-QoL was significantly higher in the PVP group than in the TURP group (median 22 + 4; range 16-27 + 3-5 vs. median 19 + 3; range 15-23 + 3-4; = 0.02). Men undergoing PVP were more likely to be on anticoagulants (PVP group = 23; 16% vs. TURP group = 2; 2%, < 0.001). The median operation time (OT; min) for both procedures was comparable with 68 min (PVP group; range 53-91) vs. 67 min (TURP group; range 46-85). The rate of severe intraoperative bleeding was significantly lower in the PVP group than in the TURP group ( = 7; 5% vs. = 16; 14%; = 0.01). The postoperative catheterization time and length of hospital stay was significantly lower in the PVP group (median 1-2 days; range 1-4) vs. the TURP group (median 2-4 days; range 2-5; both < 0.001). Complication rates (Clavien-Dindo classification ≥III) based on the follow-up data showed no statistically significant difference between the PVP group and the TURP group ( = 6; 4% vs. = 6; 5%; = 0.28). The IPSS on follow-up showed an equivalent reduction in symptoms for both treatment modalities (IPSS-QoL of 5 + 1; range 2-11 + 0-2 for both). There were no differences concerning urge (PVP group = 3; 2% vs. TURP group = 3; 3%; = 0.90) and men were similarly satisfied with the postoperative outcome (PVP group 92% vs. TURP group 87%; = 0.43). The PVP group was associated with a shorter hospitalization time and showed a reduced risk of bleeding, despite patients remaining on anticoagulants, without increasing the overall operative time. There was no difference in the patient reported outcome for both procedures.
本文旨在比较使用绿激光 XPS 180 瓦系统进行前列腺光选择性汽化术（PVP）与经尿道前列腺切除术（TURP）的围手术期和术后结果。这项回顾性研究纳入了 2010 年 6 月至 2015 年 2 月期间因症状性良性前列腺增生（BPE）接受 PVP 的 140 名男性和接受 TURP 的 114 名男性。主要观察指标包括患者报告的结果、手术结果、国际前列腺症状评分-生活质量（IPSS-QoL）、并发症发生率、导尿时间和住院时间。PVP 组的中位随访时间为 27 个月（范围 14 - 44 个月），TURP 组为 36 个月（范围 25 - 47 个月）。两组患者特征均衡，PVP 组中位年龄 71 岁，TURP 组中位年龄 70 岁，前列腺体积相当（PVP 组中位 50 mL，TURP 组中位 45 mL）。PVP 组的 IPSS-QoL 显著高于 TURP 组（中位数 22 + 4；范围 16 - 27 + 3 - 5 对比中位数 19 + 3；范围 15 - 23 + 3 - 4；P = 0.02）。接受 PVP 的男性更可能正在使用抗凝剂（PVP 组 n = 23；16% 对比 TURP 组 n = 2；2%，P < 0.001）。两种手术的中位手术时间（OT；分钟）相当，PVP 组为 68 分钟（范围 53 - 91 分钟），TURP 组为 67 分钟（范围 46 - 85 分钟）。PVP 组严重术中出血率显著低于 TURP 组（n = 7；5% 对比 n = 16；14%；P = 0.01）。PVP 组术后导尿时间和住院时间显著短于 TURP 组（中位数 1 - 2 天；范围 1 - 4 天）对比 TURP 组（中位数 2 - 4 天；范围 2 - 5 天；两者 P < 0.001）。基于随访数据的并发症发生率（Clavien-Dindo 分级≥III）在 PVP 组和 TURP 组之间无统计学显著差异（n = 6；4% 对比 n = 6；5%；P = 0.28）。随访时的 IPSS 显示两种治疗方式症状减轻程度相当（IPSS-QoL 均为 5 + 1；范围 2 - 11 + 0 - 2）。急迫性方面无差异（PVP 组 n = 3；2% 对比 TURP 组 n = 3；3%；P = 0.90），患者对术后结果的满意度相似（PVP组 92% 对比 TURP 组 87%；P = 0.43）。PVP 组住院时间较短，出血风险降低，尽管患者继续使用抗凝剂，但未增加总体手术时间。两种手术患者报告的结果无差异。
