经钬激光前列腺剜除术后的长期再干预：1000 多例患者 12 年的经验。
Long-term Reinterventions after Thulium Laser Enucleation of the Prostate: 12-Year Experience with more than 1000 Patients.
机构信息
Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany.
Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany; Department of Biomedical Informatics at the Center for Preventive Medicine and Digital Health, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany.
出版信息
Eur Urol Focus. 2022 Sep;8(5):1370-1375. doi: 10.1016/j.euf.2021.12.006. Epub 2022 Jan 10.
BACKGROUND
Thulium laser enucleation of the prostate (ThuLEP) is an established treatment option for benign prostatic enlargement (BPE), but long-term outcomes have not yet been reported.
OBJECTIVE
To prove the durability of ThuLEP by investigating its long-term efficacy and morbidity.
DESIGN, SETTING, AND PARTICIPANTS: All patients who underwent ThuLEP at a German tertiary referral center between 2009 and 2021 were retrospectively followed up for reinterventions for persistence or regrowth of prostate adenoma (ReIP) or long-term complications (ReIC).
INTERVENTION
ThuLEP.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
We calculated the cumulative incidence for ReIP and ReIC at 10 yr. Univariate and multivariate Cox regression models were constructed to identify predictors of ReIP and ReIC.
RESULTS AND LIMITATIONS
Overall, 1097 patients underwent ThuLEP. The median overall follow-up was 6.0 yr (interquartile range [IQR] 2.4-9.2). For one-third of patients (n = 369), median follow-up of 10 yr (IQR 9.1-11.2) was available. A total of 42 patients (3.8%) underwent ReIP after a median of 2 yr (IQR 0.3-4.9). The rate of long-term ReIC was 2.6% (n = 29) and the median time to ReIC was 0.5 yr (IQR 0.3-1.7). The most frequent ReIC was urethrotomy (n = 16, 1.5%). The cumulative incidence of ReIP and ReIC at 10 yr was estimated at 5.6% and 3.4%, respectively. Enucleation weight ≥60 g was a significant predictor of ReIP (hazard ratio 1.2, p = 0.014). The retrospective study design and the lack of functional outcomes are the main limitations.
CONCLUSIONS
ThuLEP is a durably effective and safe procedure with low reintervention rates within 12 yr.
PATIENT SUMMARY
This study investigated long-term outcomes of thulium laser enucleation of the prostate for benign enlargement of the prostate (BPE). Low rates of repeat treatment for BPE recurrence or for other complications were observed. Our results show the safety and efficacy of this treatment over a period of 12 years.
背景
钬激光前列腺剜除术（ThuLEP）是治疗良性前列腺增生（BPE）的一种成熟的治疗选择，但尚未报告其长期疗效。
目的
通过研究其长期疗效和发病率来证明 ThuLEP 的持久性。
设计、地点和参与者：回顾性随访了 2009 年至 2021 年期间在德国一家三级转诊中心接受 ThuLEP 治疗的所有患者，以了解前列腺腺瘤（ReIP）持续存在或复发或长期并发症（ReIC）的再干预情况。
干预措施
ThuLEP。
测量和统计分析结果
我们计算了 10 年时 ReIP 和 ReIC 的累积发生率。构建了单变量和多变量 Cox 回归模型，以确定 ReIP 和 ReIC 的预测因素。
结果和局限性
总体而言，有 1097 名患者接受了 ThuLEP 治疗。中位总随访时间为 6.0 年（四分位距 [IQR] 2.4-9.2）。对于三分之一的患者（n = 369），可获得中位随访 10 年（IQR 9.1-11.2）。中位随访 2 年后（IQR 0.3-4.9），有 42 名患者（3.8%）接受了 ReIP。长期 ReIC 的发生率为 2.6%（n = 29），ReIC 的中位时间为 0.5 年（IQR 0.3-1.7）。最常见的 ReIC 是尿道扩张术（n = 16，1.5%）。10 年时 ReIP 和 ReIC 的累积发生率分别估计为 5.6%和 3.4%。剜除重量≥60g 是 ReIP 的显著预测因素（风险比 1.2，p = 0.014）。回顾性研究设计和缺乏功能结果是主要的局限性。
结论
ThuLEP 是一种安全有效的手术，12 年内再干预率较低。
患者总结
本研究调查了钬激光前列腺剜除术治疗良性前列腺增生的长期疗效。观察到 BPE 复发或其他并发症的重复治疗率较低。我们的研究结果表明，这种治疗方法在 12 年的时间内具有安全性和有效性。
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