Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá, Distrito Capital, Colombia.
Neurourol Urodyn. 2021 Mar;40(3):868-875. doi: 10.1002/nau.24637. Epub 2021 Mar 1.
Previous studies suggest that men with detrusor underactivity (DUA) have less symptomatic improvement after prostate surgery than those with normal contractility, but the available data is controversial. We aim to determine the differences in functional outcomes of patients with or without DUA who underwent photovaporization of the prostate (PVP) with GreenLight™180 W XPS.
A cohort of patients with lower urinary tract symptoms (LUTS) who underwent PVP between 2012 and 2019 was evaluated. Patients were stratified according to bladder contractility index (BCI). DUA was defined as BCI < 100. Those with normal contractility (BCI = 100-150) were included in Group 1, and those with DUA (BCI < 100) in Group 2. Primary outcomes were symptomatic improvement defined as a reduction ≥ 4 points in the international prostate symptom score (IPSS) and a reduction of at least 1 point in the quality of life (IPSS-QoL). Complications according to the Clavien-Dindo classification were also recorded.
A total of 271 patients who underwent PVP with GreenLight™ and met the inclusion criteria were assessed. Group 1 included 158 patients, while Group 2 included 113 patients. Mean follow-up was 24 months. Patients with normal contractility had a median reduction of 11 points (18.9 ± 8.0 to 7.1 ± 7.0) while patients with DUA had a median reduction of 10 points (19.3 ± 6.9 to 8.6 ± 8.4) in IPSS score; these differences were not statistically significant (p = .20). Patients in Group 1 had a 1.92 higher chance of QoL improvement (OR, 1.92; 90% CI, 1.10-3.37), compared to those in Group 2. Failure to void after PVP was most frequently reported in DUA patients (OR, 2.36; 90% CI, 1.26-4.43). Sociodemographic characteristics, intraoperative complications, conversion rates, hospital stay, and urinary catheterization time were similar between groups.
Patients with LUTS, regardless of their BCI, improved their symptoms after PVP according to the IPSS. However, patients with DUA were more likely not to improve their QoL after the procedure and had a higher chance of failure to void in the immediate postoperative period. An appropriate counseling process with the patient discussing possible outcomes based on these findings should be encouraged.
先前的研究表明，与收缩力正常的患者相比，逼尿肌活动低下（DUA）的男性在前列腺手术后症状改善程度较低，但现有数据存在争议。我们旨在确定接受 GreenLight™180W XPS 前列腺光汽化术（PVP）的有或无 DUA 的患者在功能结局方面的差异。
评估了 2012 年至 2019 年间接受 PVP 的下尿路症状（LUTS）患者队列。根据膀胱收缩力指数（BCI）对患者进行分层。定义逼尿肌活动低下（BCI＜100）。收缩力正常（BCI=100-150）的患者纳入第 1 组，逼尿肌活动低下（BCI＜100）的患者纳入第 2 组。主要结局为国际前列腺症状评分（IPSS）降低≥4 分和生活质量（IPSS-QoL）至少降低 1 分定义的症状改善。还记录了根据 Clavien-Dindo 分类的并发症。
共评估了 271 名接受 GreenLight™和符合纳入标准的 PVP 患者。第 1 组包括 158 名患者，第 2 组包括 113 名患者。平均随访时间为 24 个月。收缩力正常的患者 IPSS 评分中位数降低 11 分（18.9±8.0 至 7.1±7.0），逼尿肌活动低下的患者 IPSS 评分中位数降低 10 分（19.3±6.9 至 8.6±8.4）；这些差异无统计学意义（p=0.20）。与第 2 组相比，第 1 组患者改善生活质量的可能性高 1.92 倍（OR，1.92；90%CI，1.10-3.37）。PVP 后无法排尿的情况在逼尿肌活动低下的患者中最为常见（OR，2.36；90%CI，1.26-4.43）。两组之间的社会人口统计学特征、术中并发症、转换率、住院时间和导尿管时间相似。
无论 BCI 如何，患有 LUTS 的患者在接受 PVP 后根据 IPSS 改善了症状。然而，逼尿肌活动低下的患者术后更有可能无法改善生活质量，并且在术后即刻排尿失败的可能性更高。应鼓励患者与患者进行适当的咨询过程，根据这些发现讨论可能的结果。
