The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD.
The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD.
Urology. 2021 Aug;154:237-242. doi: 10.1016/j.urology.2021.01.025. Epub 2021 Jan 23.
To examine the long-term efficacy of prostatic urethral lift (PUL) for treating men, with or without an obstructive median lobe (OML), who suffer from lower urinary tract symptoms attributed to benign prostatic hyperplasia.
A retrospective review was performed on all consecutive PUL cases with or without OML from October 2017 to November 2019 by a single academic surgeon. Outcomes were measured using the International Prostate Symptoms Survey (IPSS) with quality of life (QoL) scores. Comparative testing and mixed-effects linear regression analysis were utilized with significance set at α = 0.05 and performed with Stata (College Station, TX).
A total of 110 PUL procedures were performed on 106 patients (4 repeat surgeries) with a median age of 66.5 (interquartile range: 60.4-73.7). Twenty-three patients (21.7%) had an OML. Following PUL, patients in both groups showed significant improvements in IPSS (P <.001) and QoL (P <.001) scores. When stratifying by OML and controlling for confounding, IPSS scores in both groups displayed statistically significant improvement at follow-up visits, with no statistically significant intergroup difference (P = .32). The same held true for QoL improvements, with no statistically significant difference between groups (P = .18). The presence of an OML resulted in minimal effects on perioperative outcomes and complications but required significantly more implants (P = .008).
PUL is a minimally invasive procedure effective at reducing lower urinary tract symptoms and improving the lives of men with benign prostatic hyperplasia without incurring risks of serious complications. These improvements were equivalent and upheld in patients who presented with OML.
探讨前列腺尿道吊带术（PUL）治疗下尿路症状（LUTS）归因于良性前列腺增生（BPH）男性患者的长期疗效，无论患者是否存在阻塞性中叶（OML）。
回顾性分析了 2017 年 10 月至 2019 年 11 月间由一位学术型外科医生进行的所有连续 PUL 病例（伴或不伴 OML）。使用国际前列腺症状评分（IPSS）和生活质量评分（QoL）评估结果。采用比较检验和混合效应线性回归分析，显著性水平为α=0.05，使用 Stata（德克萨斯州学院站）进行分析。
106 例患者（4 例重复手术）共行 110 例 PUL 手术，中位年龄为 66.5（四分位间距：60.4-73.7）。23 例（21.7%）患者存在 OML。PUL 后，两组患者的 IPSS（P<0.001）和 QoL（P<0.001）评分均显著改善。在按 OML 分层并控制混杂因素后，两组患者的 IPSS 评分在随访时均显示出统计学上的显著改善，组间无统计学差异（P=0.32）。QoL 改善也如此，两组间无统计学差异（P=0.18）。存在 OML 仅对围手术期结局和并发症产生微小影响，但需要使用更多的植入物（P=0.008）。
PUL 是一种微创治疗方法，可有效减轻 LUTS，改善 BPH 男性的生活质量，且不会产生严重并发症的风险。这些改善在伴有 OML 的患者中是等效的。
