Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
J Urol. 2020 Apr;203(4):792-801. doi: 10.1097/JU.0000000000000685. Epub 2019 Nov 25.
In a preliminary clinical trial we assessed the efficacy of ejaculatory hood sparing GreenLight™ Laser prostate photoselective vaporization to preserve antegrade ejaculation and urodynamic relief of obstruction compared to standard GreenLight prostate photoselective vaporization.
Standard prostate photoselective vaporization was classically performed in 24 patients. Ejaculatory hood sparing vaporization was performed with preservation of the paracollicular and supracollicular tissue proximal to the verumontanum in 25 patients. Patients were assessed at baseline, and 1, 3, 6 and 12 months postoperatively using the Ej-MSHQ (Ejaculatory Domain of Male Sexual Health Questionnaire) and the IIEF-15 (International Index of Erectile Function-15). The I-PSS (International Prostate Symptom Score), uroflowmetry and post-void residual urine volume were reported at each followup visit. A standard urodynamic study was performed at 6 months.
Antegrade ejaculation was reported in 85% and 31.6% of patients after hood sparing and standard prostate vaporization, respectively (p=0.001). A significant reduction in the EJ-MSHQ score was reported after standard vaporization at 6 and 12 months (each p <0.001) with no significant difference after hood sparing vaporization (p=0.18 and 0.078, respectively). The median EJ-MSHQ score was 28.5 (range 1 to 33) and 27 (range 1 to 33) for hood sparing vaporization, and 9.5 (range 1 to 35) and 9 (range 0 to 33) for standard vaporization at 6 (p=0.005) and 12 months (p <0.001), respectively. Each group showed a decline in the mean total IIEF-15 score at 1 year but it was statistically significant only after standard vaporization (p=0.001). All urinary outcome measures revealed comparable significant improvement at all followups. Postoperative urodynamic assessment demonstrated a significant comparable decrease in the Bladder Outlet Obstruction Index from a median of 64 (range 21 to 207) to 23.5 (range 10 to 53) after hood sparing vaporization (p=0.005) and from 87 (range 38 to 186) to 19.5 (range 7 to 51) after standard vaporization (p=0.001). At 1 year the overall re-treatment rate was comparable in the 2 groups (p=0.26).
In well informed, sexually interested patients ejaculatory hood sparing GreenLight prostate photoselective vaporization is feasible and effective treatment of small to moderate sized benign prostatic hyperplasia with a superior sexual function related outcome. Short-term relief of obstruction is objectively comparable to that of standard prostate photoselective vaporization.
在一项初步的临床试验中，我们评估了射精罩保留式绿激光前列腺光选择性汽化术治疗小至中度良性前列腺增生的疗效，与标准绿激光前列腺光选择性汽化术相比，该术式可保留逆行射精和尿动力学梗阻缓解。
在 24 例患者中进行了标准前列腺光选择性汽化术。在 25 例患者中，进行了射精罩保留式汽化术，保留了精阜近端的旁丘和上丘组织。在基线时以及术后 1、3、6 和 12 个月，使用 Ej-MSHQ（男性性健康问卷的射精域）和 IIEF-15（国际勃起功能指数-15）对患者进行评估。在每次随访时报告 I-PSS（国际前列腺症状评分）、尿流率和残余尿量。在 6 个月时进行了标准尿动力学研究。
射精罩保留式汽化术和标准前列腺汽化术的患者中，逆行射精的发生率分别为 85%和 31.6%（p=0.001）。标准汽化术后 6 和 12 个月时，EJ-MSHQ 评分显著降低（p<0.001），而射精罩保留式汽化术后无显著差异（p=0.18 和 0.078）。射精罩保留式汽化术的 EJ-MSHQ 评分中位数为 28.5（范围 1 至 33）和 27（范围 1 至 33），标准汽化术分别为 9.5（范围 1 至 35）和 9（范围 0 至 33），6 个月（p=0.005）和 12 个月（p<0.001）时差异有统计学意义。两组患者在第 1 年时的平均 IIEF-15 总分均有所下降，但仅在标准汽化术后有统计学意义（p=0.001）。所有尿动力学评估均显示所有随访时均有显著的改善。术后尿动力学评估显示，射精罩保留式汽化术后膀胱出口梗阻指数从 64（范围 21 至 207）中位数显著下降至 23.5（范围 10 至 53）（p=0.005），标准汽化术后从 87（范围 38 至 186）中位数显著下降至 19.5（范围 7 至 51）（p=0.001）。在第 1 年，两组的总体再治疗率相当（p=0.26）。
在知情同意、有性兴趣的患者中，射精罩保留式绿激光前列腺光选择性汽化术是一种可行且有效的治疗小至中度良性前列腺增生的方法，具有更好的与性功能相关的疗效。短期梗阻缓解的效果与标准前列腺光选择性汽化术相当。
