Department of Urology, San Carlo di Nancy Hospital, Rome, Italy.
Department of Urology, San Carlo di Nancy Hospital, Rome, Italy.
Actas Urol Esp (Engl Ed). 2021 Dec;45(10):648-655. doi: 10.1016/j.acuroe.2020.09.011. Epub 2021 Nov 11.
To evaluate if thulium laser vapoenucleation of the prostate (ThuVEP) is equally safe and effective in a selected cohort of elderly patients when compared to "younger" patients.
We performed a retrospective analysis of consecutive patients who underwent ThuVEP between September 2018 and February 2020. After application of the inclusion/exclusion criteria, patients were stratified according to the 75 years-old cut-off point suggested by the WHO. Group A included patients ≤75 years-old; Group B included patients >75 years-old. Preoperative assessment included urological consultation, prostate specific antigen (PSA), International Prostate Symptom Score (IPSS) and quality of life index, transrectal ultrasound to estimate prostate volume (PVol), and uroflowmetry to assess preoperative Qmax, Qave and post-void residual volume (PVR). Perioperative and postoperative data were analyzed during 3-month follow-up.
After propensity-score analysis, 51 versus 51 patients were 1:1 matched according to PVol, PSA, Qmax, IPSS and QoL. Patients were comparable at baseline excluding age (65 (IQR 59-70) versus 79 (IQR 77-82) years, Group A versus B, respectively, P-value <.001). No differences were found in terms of hemoglobin drop, complications rate, catheterization time and length of hospital stay. Group A (younger) patients had more significant improvement in 30-days absolute Qmax, Qave and ΔQmax. At 90-days follow-up, the differences between the groups disappeared. Within the 90-days follow-up, no significant differences were found in the readmission rate, with no need of reinterventions.
In our hands, even in elderly patients affected by BPH, ThuVEP appears to be a safe and effective treatment option.
评估经钬激光前列腺汽化切除术（ThuVEP）治疗时，与“年轻”患者相比，在选择的老年患者队列中是否同样安全有效。
我们对 2018 年 9 月至 2020 年 2 月期间接受 ThuVEP 的连续患者进行了回顾性分析。应用纳入/排除标准后，根据世界卫生组织（WHO）建议的 75 岁临界值将患者分层。A 组包括年龄≤75 岁的患者；B 组包括年龄>75 岁的患者。术前评估包括泌尿科咨询、前列腺特异性抗原（PSA）、国际前列腺症状评分（IPSS）和生活质量指数、经直肠超声估计前列腺体积（PVol）以及尿流率评估术前最大尿流率（Qmax）、平均尿流率（Qave）和残余尿量（PVR）。在 3 个月随访期间分析围手术期和术后数据。
经倾向评分分析，根据 PVol、PSA、Qmax、IPSS 和 QoL 1:1 匹配了 51 例患者和 51 例患者。除年龄（A 组：65（IQR 59-70）岁；B 组：79（IQR 77-82）岁）外，两组患者基线情况相当（P<0.001）。在血红蛋白下降、并发症发生率、导管时间和住院时间方面，两组间无差异。A 组（年轻）患者在 30 天绝对 Qmax、Qave 和ΔQmax 方面有更显著的改善。在 90 天随访时，两组间的差异消失。在 90 天随访期间，再入院率无显著差异，且无需再次干预。
在我们的手中，即使是患有 BPH 的老年患者，ThuVEP 似乎也是一种安全有效的治疗选择。
