Yu Jiwoong, Jeong Byong Chang, Jeon Seong Soo, Lee Sung Won, Lee Kyu-Sung
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea.
Int Neurourol J. 2021 Sep;25(3):252-262. doi: 10.5213/inj.2040314.157. Epub 2021 May 5.
We compared success rates of 3 surgical techniques (holmium laser enucleation of the prostate [HoLEP], transurethral resection of the prostate [TURP], and photoselective laser vaporization prostatectomy [PVP]) for treatment of benign prostatic obstruction (BPO). We aimed to identify preoperative clinical variables and urodynamic parameters that predict surgical success.
A total of 483 patients who underwent surgical treatment for BPO at Samsung Medical Center between 2006 and 2017 were retrospectively analyzed; of these 361, 81, and 41 patients underwent HoLEP, TURP, and PVP, respectively. Prostate-specific antigen, prostate volume, urodynamic parameters, and International Prostate Symptom Score (IPSS)/quality of life (QoL) index were evaluated preoperatively; uroflowmetry, postvoid residual urine, and IPSS/QoL index were measured 6 months postoperatively. Surgical success was defined based on IPSS, maximum flow rate, and QoL index and predictive factors were identified using multiple logistic regression analyses.
Success rates of HoLEP, TURP, and PVP were 67.6%, 65.4%, and 34.1%, respectively, and the HoLEP and TURP groups were not significantly different. Regression analysis revealed prostate volume ≥50 mL and bladder outlet obstruction index (BOOI) ≥40 to be independent factors predicting HoLEP success. Only high preoperative QoL could predict the success of TURP, whereas other urodynamic parameters remained unrelated.
Patients treated with HoLEP and TURP displayed equivalent efficacies, but PVP was relatively less efficient than both. Preoperative variables of prostate volume ≥50 mL and BOOI ≥40 were independent predictive factors for the success of HoLEP but not of TURP.
我们比较了三种手术技术（钬激光前列腺剜除术[HoLEP]、经尿道前列腺切除术[TURP]和选择性激光汽化前列腺切除术[PVP]）治疗良性前列腺梗阻（BPO）的成功率。我们旨在确定预测手术成功的术前临床变量和尿动力学参数。
回顾性分析2006年至2017年在三星医疗中心接受BPO手术治疗的483例患者；其中361例、81例和41例患者分别接受了HoLEP、TURP和PVP手术。术前评估前列腺特异性抗原、前列腺体积、尿动力学参数以及国际前列腺症状评分（IPSS）/生活质量（QoL）指数；术后6个月测量尿流率、残余尿量和IPSS/QoL指数。根据IPSS、最大尿流率和QoL指数定义手术成功，并使用多元逻辑回归分析确定预测因素。
HoLEP、TURP和PVP的成功率分别为67.6%、65.4%和34.1%，HoLEP组和TURP组无显著差异。回归分析显示前列腺体积≥50 mL和膀胱出口梗阻指数（BOOI）≥40是预测HoLEP成功的独立因素。只有术前高QoL可预测TURP的成功，而其他尿动力学参数与之无关。
接受HoLEP和TURP治疗的患者疗效相当，但PVP相对效率较低。前列腺体积≥50 mL和BOOI≥40的术前变量是HoLEP成功的独立预测因素，而非TURP成功的预测因素。
