Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
World J Urol. 2022 Jul;40(7):1755-1762. doi: 10.1007/s00345-022-03986-5. Epub 2022 Mar 26.
We sought to characterize the adjusted outcomes of GreenLight photoselective vaporization of the prostate (PVP) in high-medical-risk (HMR) patients using data from the largest international database.
Data were obtained from the Global GreenLight Group (GGG) database which pools data of eight high-volume, experienced surgeons, from a total of seven international centers. Eligible study participants underwent GreenLight PVP using the XPS-180 W system between 2011 and 2019. HMR patients were defined as patients with ASA III or greater and were compared to non-HMR patients. Analyses were adjusted for patient age and prostate volume.
In the HMR group, patients on average were older and had smaller prostates than the non-HMR control group. Compared to non-HMR patients, transfusions occurred more frequently (2.6% vs. 0.14%, p < 0.01) and the odds of readmission were elevated [OR 2.0, (95% CI 1.4-2.8, p < 0.01)] among HMR patients. Twelve months postoperatively, HMR patients experience greater improvement in QoL than the control group [+ 0.54 (95% CI 0.07-1.0, p = 0.02)]. PVR also decreased 93.1 ml more in HMR than in non-HMR patients after 12 months (95% CI 33.6-152.6, p < 0.01).
We found that GreenLight PVP is safe and effective in improving functional outcomes in higher-risk patients with severe systemic disease compared to their lower-risk counterparts. Though absolute risks remain low, GreenLight PVP is associated with higher odds of transfusion and readmission in the high-risk cohort. The findings of our study reaffirm current guidelines that propose PVP as a viable treatment option for HMR patients.
我们旨在利用最大的国际数据库中的数据，对高医学风险（HMR）患者进行绿光前列腺选择性汽化术（PVP）的调整后结局进行特征描述。
数据来自全球绿光集团（GGG）数据库，该数据库汇集了来自七个国际中心的八名经验丰富的高容量外科医生的数据。合格的研究参与者在 2011 年至 2019 年间使用 XPS-180 W 系统接受绿光 PVP 治疗。HMR 患者被定义为 ASA 分级 III 级或更高的患者，并与非 HMR 患者进行比较。分析调整了患者年龄和前列腺体积。
在 HMR 组中，患者平均年龄较大，前列腺体积较小。与非 HMR 对照组相比，HMR 患者输血更常见（2.6%比 0.14%，p<0.01），HMR 患者的再入院几率更高[比值比 2.0（95%置信区间 1.4-2.8，p<0.01)]。术后 12 个月，HMR 患者的生活质量改善程度大于对照组[+0.54（95%置信区间 0.07-1.0，p=0.02）]。与非 HMR 患者相比，HMR 患者在 12 个月后 PVR 减少了 93.1 毫升[95%置信区间 33.6-152.6，p<0.01）]。
我们发现，与低风险患者相比，绿光 PVP 治疗高危伴严重系统性疾病患者在改善功能结局方面是安全且有效的。尽管绝对风险仍然较低，但绿光 PVP 与高危患者输血和再入院的几率增加相关。我们的研究结果再次证实了现行指南，即建议将 PVP 作为 HMR 患者的一种可行治疗选择。
