Faculty of Medicine, McGill University, Montreal, QC, Canada.
Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada.
World J Urol. 2021 Oct;39(10):3881-3889. doi: 10.1007/s00345-020-03529-w. Epub 2021 Jan 3.
Previous analyses of the impact of median lobe presence on Greenlight photoselective vaporization of the prostate (PVP) outcomes were limited by their small sample size and the ability to adjust for important confounders. As such, we sought to investigate the impact of prostate median lobe presence on the operative outcomes of 180 W XPS GreenLight PVP using a large international database.
Data were obtained from the Global GreenLight Group (GGG) database which pools data of eight high-volume, experienced surgeons, from a total of seven international centers. All men with established benign prostatic hyperplasia who underwent GreenLight PVP using the XPS-180 W system between 2011 and 2019 were eligible for the study. Patients were assigned to two groups based on presence or absence of median lobes. Analyses were adjusted for patient age, prostate volume, body mass index, and American Society of Anesthesia (ASA) score.
A total of 1650 men met the inclusion criteria. A median lobe was identified in 621 (37.6%) patients. Baseline prostate volume, patient age, and ASA score varied considerably between the two groups. In adjusted analyses, the operative and lasing time of patients with median lobes was 6.72 (95% CI 3.22-10.23; p < 0.01) minutes and 2.90 (95% CI 1.02-4.78; p < 0.01) minutes longer than the control group. Men with median lobes had similar postoperative functional outcomes to those without a median lobe except for a 1.59-point greater drop in the 12-month IPSS score compared to baseline (95% CI 0.11-3.08; p = 0.04) in the median lobe group, and a decrease in PVR after 6 months which was 46.51 ml (95% CI 4.65-88.36; p = 0.03) greater in patients with median lobes compared to men without median lobes.
Our findings suggest that the presence of a median lobe has no clinically significant impact on procedural or postoperative outcomes for patients undergoing Greenlight PVP using the XPS-180 W system.
先前关于中叶存在对绿光前列腺选择性汽化术（PVP）结果影响的分析受到样本量小和调整重要混杂因素能力的限制。因此，我们试图使用大型国际数据库研究前列腺中叶存在对 180W XPS 绿光 PVP 手术结果的影响。
数据来自全球绿光集团（GGG）数据库，该数据库汇集了来自七个国际中心的八位经验丰富的高容量外科医生的数据。所有患有明确良性前列腺增生并在 2011 年至 2019 年间使用 XPS-180W 系统接受绿光 PVP 的男性均符合研究条件。根据中叶是否存在，将患者分为两组。分析调整了患者年龄、前列腺体积、体重指数和美国麻醉医师协会（ASA）评分。
共有 1650 名男性符合纳入标准。在 621 名（37.6%）患者中发现了中叶。两组之间的前列腺体积、患者年龄和 ASA 评分差异很大。在调整分析中，中叶患者的手术和激光时间分别为 6.72 分钟（95%CI 3.22-10.23；p<0.01）和 2.90 分钟（95%CI 1.02-4.78；p<0.01）比对照组长。中叶患者的术后功能结局与无中叶患者相似，但中叶组术后 12 个月 IPSS 评分较基线下降 1.59 分（95%CI 0.11-3.08；p=0.04），且中叶患者术后 6 个月时的 PVR 下降 46.51ml（95%CI 4.65-88.36；p=0.03）大于无中叶患者。
我们的发现表明，在使用 XPS-180W 系统进行绿光 PVP 时，中叶的存在对手术过程或术后结果没有临床意义上的影响。
