Ahn Sun-Tae, Lee Dong-Hyun, Cho Sun-Bum, Lee Hyun-Soo, Han Da-Eun, Park Tae-Yong, Moon Du-Geon
Department of Urology, Korea University Guro Hospital, No. 148, Gurodong-ro, Guro-gu, Seoul 08308, Korea.
Department of Urology, Uijeongbu Eulji Medical Center, Eulji University, Dongil-ro 712, Uijeongbu-si 11759, Korea.
J Clin Med. 2022 Mar 30;11(7):1928. doi: 10.3390/jcm11071928.
A prostatic urethral lift (PUL) can be performed under local anesthesia in patients normally at high risk for general anesthesia due to multiple comorbidities. However, the clinical efficacy of PULs in patients with multiple comorbidities remains unknown. Therefore, in this this study, we aimed to evaluate the clinical efficacy of the PUL in patients with a high number of comorbidities by comparing its clinical efficacy in these patients with that in healthy individuals. We performed a retrospective observational cohort study, in which patients who underwent a PUL between December 2016 and January 2019 at a single tertiary care center were categorized into two groups: healthy individuals who wanted to preserve sexual function (Group 1) and patients with a high number of comorbidities who were at high risk for general anesthesia, based on an American Society of Anesthesiologists (ASA) score of ≥3 (Group 2). The International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), and post-void residual urine (PVR) were obtained preoperatively and compared throughout the 2-year follow-up. A total of 66 patients were enrolled, of whom 36 patients were included in Group 1 and 30 in Group 2. In Group 1, IPSS, IPSS quality of life (QoL), and Qmax significantly improved and were then maintained during follow-up, whereas, in Group 2, improvements in these parameters were not maintained during follow-up, except for IPSS QoL. Eleven patients (36%) in Group 2 required additional treatment for the recurrence of lower urinary tract symptoms. In conclusion, patients with a high number of comorbidities had a low therapeutic effect after PUL, suggesting a high rate of treatment failure. Therefore, comorbidity status should be considered when evaluating the potential benefits of the PUL procedure during preoperative counseling.
由于多种合并症，通常全麻高风险的患者可在局部麻醉下进行前列腺尿道悬吊术（PUL）。然而，PUL对合并多种合并症患者的临床疗效仍不清楚。因此，在本研究中，我们旨在通过比较PUL在这些患者与健康个体中的临床疗效，评估其对合并症多的患者的临床疗效。我们进行了一项回顾性观察队列研究，将2016年12月至2019年1月在单一三级医疗中心接受PUL的患者分为两组：希望保留性功能的健康个体（第1组）和基于美国麻醉医师协会（ASA）评分≥3的合并症多且全麻高风险的患者（第2组）。术前获取国际前列腺症状评分（IPSS）、最大尿流率（Qmax）和排尿后残余尿量（PVR），并在整个2年随访期间进行比较。共纳入66例患者，其中第1组36例，第2组30例。在第1组中，IPSS、IPSS生活质量（QoL）和Qmax显著改善，并在随访期间维持，而在第2组中，除IPSS QoL外，这些参数的改善在随访期间未维持。第2组中有11例患者（36%）因下尿路症状复发需要额外治疗。总之，合并症多的患者PUL术后治疗效果低，提示治疗失败率高。因此，在术前咨询评估PUL手术的潜在益处时应考虑合并症状态。
