Department of Urology, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
Department of Urology, Tokai University Hachioji Hospital, Tokyo, Japan.
Int J Urol. 2020 Nov;27(11):974-980. doi: 10.1111/iju.14341. Epub 2020 Aug 16.
To evaluate functional outcomes over a year for benign prostatic hyperplasia treated with thulium laser enucleation of the prostate or bipolar transurethral resection of the prostate.
In this study, we prospectively included 140 patients who were treated for benign prostatic hyperplasia from April 2017 to February 2019. A randomization list was used for non-blind assignment to treatment groups (thulium laser enucleation of the prostate or bipolar transurethral resection of the prostate). The International Prostate Symptom Score, International Prostate Symptom Score quality of life, Overactive Bladder Symptom Score, uroflowmetry and International Index of Erectile Function-5 were used for the assessment of outcomes. Scores were taken before treatment, and at 1, 3, 6, 9 and 12 months after treatment.
Preoperatively, characteristics of patients in the thulium laser enucleation of the prostate group (n = 70) and the bipolar transurethral resection of the prostate group (n = 70) did not significantly differ. The thulium laser enucleation of the prostate group had a lower median decrease in hemoglobin (0.10 g/dL vs 0.69 g/dL, P < 0.0001) and shorter median catheterization (2 days vs 3 days, P < 0.0001) than the bipolar transurethral resection of the prostate group. Both groups had significantly improved International Prostate Symptom Score, International Prostate Symptom Score quality of life, Overactive Bladder Symptom Score, maximum flow rate and residual urine compared with preoperative values. In the thulium laser enucleation of the prostate group, erectile function was significantly impaired at 1 month post-treatment compared with pretreatment, but improved to baseline at 3 months; however, the transurethral resection of the prostate group did not recover. However, total energy (P = 0.001) and laser irradiation time (P = 0.025) were significantly different between the patients who had preserved erectile function and those who did not after the treatment in the thulium laser enucleation of the prostate group.
Thulium laser enucleation of the prostate is superior to bipolar transurethral resection of the prostate in resection efficacy, hemostasis, catheterization time and preservation of erectile function. However, excessive laser irradiation time in thulium laser enucleation of the prostate has the possibility to delay improvement of overactive bladder symptoms and decrease sexual function.
评估良性前列腺增生经钬激光前列腺剜除术与双极经尿道前列腺切除术治疗后一年的功能结局。
本研究前瞻性纳入了 2017 年 4 月至 2019 年 2 月期间接受良性前列腺增生治疗的 140 例患者。采用随机分组表将患者分为非盲治疗组（钬激光前列腺剜除术或双极经尿道前列腺切除术）。采用国际前列腺症状评分、国际前列腺症状评分生活质量、膀胱过度活动症症状评分、尿流率和国际勃起功能指数-5 评估结局。在治疗前以及治疗后 1、3、6、9 和 12 个月时进行评分。
术前，钬激光前列腺剜除术组（n=70）和双极经尿道前列腺切除术组（n=70）患者的特征无显著差异。与双极经尿道前列腺切除术组相比，钬激光前列腺剜除术组的血红蛋白降低中位数更低（0.10g/dL vs 0.69g/dL，P<0.0001），导尿管留置时间更短（2 天 vs 3 天，P<0.0001）。两组的国际前列腺症状评分、国际前列腺症状评分生活质量、膀胱过度活动症症状评分、最大尿流率和残余尿量与术前相比均显著改善。与术前相比，钬激光前列腺剜除术组患者在治疗后 1 个月时的勃起功能显著受损，但在 3 个月时恢复至基线；而双极经尿道前列腺切除术组未恢复。然而，在钬激光前列腺剜除术组中，保留勃起功能的患者与未保留勃起功能的患者之间，总能量（P=0.001）和激光照射时间（P=0.025）存在显著差异。
钬激光前列腺剜除术在切除效果、止血、导尿管留置时间和勃起功能保留方面优于双极经尿道前列腺切除术。然而，钬激光前列腺剜除术的激光照射时间过长可能会延迟膀胱过度活动症状的改善并降低性功能。
