前列腺尿道提升术（UroLift）与对流水蒸汽消融术（Rezum）治疗 BPH 的微创比较：3 年临床结果中改善和持久性的比较。

Prostatic urethral lift (UroLift) versus convective water vapor ablation (Rezum) for minimally invasive treatment of BPH: a comparison of improvements and durability in 3-year clinical outcomes.

机构信息

University Health Network, Toronto, Ontario, Canada.

Weill Cornell Medicine, New York, New York, USA.

出版信息

Can J Urol. 2021 Oct;28(5):10824-10833.

PMID:34657655

Abstract

INTRODUCTION

Half of men aged > 60 years will develop benign prostatic hyperplasia (BPH) with 40% of these men having moderate-to-severe lower urinary tract symptoms (LUTS). There is limited knowledge on a head-to-head comparison of prostatic urethral lift (UroLift) and convective water vapor ablation (Rezum) for the treatment of LUTS secondary to BPH. We sought to compare randomized controlled trials with 3-year clinical outcome data.

MATERIALS AND METHODS

After a thorough literature search, two multicenter sham-controlled double-blind randomized trials for UroLift and Rezum were identified and compared. Both studies had similar designs, baseline characteristics, reported outcomes, and low risks of bias.

RESULTS

Rezum and UroLift resulted in significant improvement of International Prostate Symptom Score (IPSS) at 3 months (51.4% and 49.9%, respectively) and 50% reduction of IPSS Quality of Life that was durable across all time points. At 24 and 36 months, there was a statistically significant difference in IPSS between groups, favoring Rezum (-11.2 ± 7.3 versus -9.13 ± 7.62, p = 0.04, and -11.0 ± 7.1 versus -8.83 ± 7.41, p = 0.04, respectively). While Rezum had greater improvement in Qmax at 3 months (6.4 ± 7.2 versus 4.29 ± 5.16, p < 0.01), there was no difference in improvement from 12-36 months between treatments. Only UroLift experienced improvements of Men's Sexual Health Questionnaire- Ejaculatory Dysfunction (MSHQ-EjD) function from baseline and was better than Rezum at all time points (p < 0.01). Rezum failed to significantly reduce the MSHQ-EjD bother at 3 months, while UroLift demonstrated a significant reduction of 27.56% (p < 0.01). Both systems offered equal improvements in the bother score by 12-36 months. Surgical re-treatment rates favored Rezum over Urolift (4.4% vs. 10.7%, respectively).

CONCLUSIONS

Rezum achieved a greater improvement in symptom relief compared to UroLift. Improvement in ejaculatory dysfunction in patients treated with UroLift was greater than Rezum.

摘要

简介

超过 60 岁的男性中有一半会出现良性前列腺增生（BPH），其中 40%的男性有中度至重度下尿路症状（LUTS）。对于 BPH 引起的 LUTS，前列腺尿道 lifts（UroLift）和 convective 水蒸汽消融（Rezum）的头对头比较的知识有限。我们试图比较有 3 年临床结果数据的随机对照试验。

材料和方法

经过彻底的文献搜索，确定并比较了两项 UroLift 和 Rezum 的多中心假对照双盲随机试验。这两项研究设计、基线特征、报告的结果相似，且偏倚风险低。

结果

Rezum 和 UroLift 在 3 个月时（分别为 51.4%和 49.9%）和 50%的 IPSS 生活质量降低（在所有时间点都持久）时，显著改善了国际前列腺症状评分（IPSS）。在 24 个月和 36 个月时，组间 IPSS 存在统计学差异， Rezum 组有优势（-11.2 ± 7.3 与-9.13 ± 7.62，p = 0.04 和-11.0 ± 7.1 与-8.83 ± 7.41，p = 0.04）。虽然 Rezum 在 3 个月时 Qmax 改善更大（6.4 ± 7.2 与 4.29 ± 5.16，p < 0.01），但在 12-36 个月时，两种治疗方法之间没有差异。只有 UroLift 从基线开始改善男性健康问卷-射精功能障碍（MSHQ-EjD）功能，并且在所有时间点都优于 Rezum（p < 0.01）。Rezum 在 3 个月时未能显著降低 MSHQ-EjD 的烦恼程度，而 UroLift 则显著降低了 27.56%（p < 0.01）。两种系统在 12-36 个月时都能同等程度地降低烦恼评分。再手术治疗率 Rezum 优于 UroLift（分别为 4.4%和 10.7%）。