Department of Urology, San Carlo di Nancy Hospital, Rome, Italy.
Department of Urology, LKH Hochsteiermark, Leoben, Austria.
Int Braz J Urol. 2022 Mar-Apr;48(2):328-335. doi: 10.1590/S1677-5538.IBJU.2021.0726.
To compare thulium laser enucleation of prostate (ThuLEP) versus laparoscopic trans-vesical simple prostatectomy (LSP) in the treatment of benign prostatic hyperplasia (BPH).
Data of patients who underwent surgery for "large" BPH (>80mL) at three Institutions were collected and analyzed. Two institutions performed ThuLEP only; the third institution performed LSP only. Preoperative (indwelling catheter status, prostate volume (PVol), hemoglobin (Hb), Qmax, post-voiding residual volume (PVR), IPSS, QoL, IIEF-5) and perioperative data (operative time, enucleated adenoma, catheterization time, length of stay, Hb-drop, complications) were compared. Functional (Qmax, PVR, %ΔQmax) and patient-reported outcomes (IPSS, QoL, IIEF-5, %ΔIPSS, %ΔQoL) were compared at last follow-up.
80 and 115 patients underwent LSP and ThuLEP, respectively. At baseline, median PVol was 130 versus 120mL, p <0.001; Qmax 9.6 vs. 7.1mL/s, p=0.005; IPSS 21 versus 25, p <0.001. Groups were comparable in terms of intraoperative complications (1 during LSP vs. 3 during ThuLEP) and transfusions (1 per group). Differences in terms of operative time (156 vs. 92 minutes, p <0.001), Hb-drop (-2.5 vs. -0.9g/dL, p <0.001), catheterization time (5 vs. 2 days, p <0.001) and postoperative complications (13.8% vs. 0, p <0.001) favored ThuLEP. At median follow-up of 40 months after LSP versus 30 after ThuLEP (p <0.001), Qmax improved by 226% vs. 205% (p=0.5), IPSS decreased by 88% versus 85% (p=0.9), QoL decreased by 80% with IIEF-5 remaining almost unmodified for both the approaches.
Our analysis showed that LSP and ThuLEP are comparable in relieving from BPO and improving the patient-reported outcomes. Invasiveness of LSP is more significant.
比较钬激光前列腺剜除术（ThuLEP）与经膀胱单纯前列腺切除术（LSP）治疗良性前列腺增生（BPH）的疗效。
收集并分析了三所机构行手术治疗“大”BPH（>80mL）患者的数据。两所机构仅行 ThuLEP，第三所机构仅行 LSP。比较了术前（留置导尿管状态、前列腺体积（PVol）、血红蛋白（Hb）、最大尿流率（Qmax）、剩余尿量（PVR）、国际前列腺症状评分（IPSS）、生活质量评分（QoL）、勃起功能国际指数-5 评分（IIEF-5））和围手术期数据（手术时间、剜除的前列腺腺瘤、导尿管留置时间、住院时间、Hb 下降、并发症）。在最后一次随访时比较了功能（Qmax、PVR、%ΔQmax）和患者报告的结局（IPSS、QoL、IIEF-5、%ΔIPSS、%ΔQoL）。
LSP 和 ThuLEP 组分别有 80 例和 115 例患者。基线时，中位 PVol 分别为 130 毫升和 120 毫升（p<0.001）；Qmax 分别为 9.6 毫升/秒和 7.1 毫升/秒（p=0.005）；IPSS 分别为 21 分和 25 分（p<0.001）。两组术中并发症（LSP 组 1 例，ThuLEP 组 3 例）和输血（每组 1 例）发生率相当。手术时间（156 分钟比 92 分钟，p<0.001）、Hb 下降（-2.5 克/分升比-0.9 克/分升，p<0.001）、导尿管留置时间（5 天比 2 天，p<0.001）和术后并发症（13.8%比 0，p<0.001）方面，ThuLEP 组更具优势。LSP 组的中位随访时间为 40 个月，而 ThuLEP 组为 30 个月（p<0.001），Qmax 分别改善了 226%和 205%（p=0.5），IPSS 分别降低了 88%和 85%（p=0.9），QoL 分别降低了 80%，而 IIEF-5 则几乎保持不变。
我们的分析表明，LSP 和 ThuLEP 在缓解 BPO 和改善患者报告的结局方面疗效相当。LSP 的侵袭性更强。
