脉冲波与连续波铥光纤激光前列腺剜除术（ThuFLEP）：围手术期结果比较。

Pulsed-wave vs Continuous-wave Thulium Fiber Laser Enucleation of the Prostate (ThuFLEP): A Comparison of Perioperative Outcomes.

机构信息

Department of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Italy.

出版信息

Urology. 2023 Aug;178:120-124. doi: 10.1016/j.urology.2023.05.013. Epub 2023 May 29.

DOI:10.1016/j.urology.2023.05.013

PMID:37257589

Abstract

OBJECTIVE

To compare intra and early postoperative outcomes between pulsed-wave and continuous-wave Thulium Fiber Laser Enucleation of the Prostate (PW-ThuFLEP vs CW-ThuFLEP) for the treatment of benign prostatic hyperplasia.

METHODS

238 patients with lower urinary tract symptoms due to benign prostatic hyperplasia underwent PW-ThuFLEP (118 patients) vs CW-ThuFLEP (120 patients). Preoperative prostate volume, adenoma volume, prostate-specific antigen (PSA), and hemoglobin values were recorded. International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), post-void residual volume, and International Index of Erectile Function-5 score (IIEF-5) were assessed. Operative time, enucleation time, enucleation efficiency, catheterization time, irrigation volume, hospital stay, hemoglobin drop, and postoperative complications were recorded. Micturition improvements and sexual outcomes were evaluated 3months after surgery.

RESULTS

CW-ThuFLEP showed shorter operative time (61.5 vs 67.4 minutes, P = .04). Enucleation time (50.2 vs 53.3 minutes, P = .12), enucleation efficiency (0.8 vs 0.7 g/min, P = .38), catheterization time (2.2 vs 2.1days, P = .29), irrigation volume (32.9 vs 32.8L, P = .71), hospital stay (2.8 vs 2.6days, P = .29) and hemoglobin drop (0.38 vs 0.39 g/dL, P = .53) were comparable. No significant difference in complication rate was observed. At 3-month follow-up, the procedures did not show any significant difference in IPSS, Qmax, post-void residual volume, IIEF-5, and PSA value.

CONCLUSION

PW-ThuFLEP and CW-ThuFLEP both relieve lower urinary tract symptoms equally, with high efficacy and safety. Operative time was significantly shorter with CW-ThuFLEP, but with a small difference with low clinical impact. Enucleation time, enucleation efficiency, catheterization time, irrigation volume, hospital stay, hemoglobin and PSA drop, complication rate, and sexual outcomes showed no differences.

摘要

目的

比较脉冲波和连续波铥光纤激光前列腺剜除术（PW-ThuFLEP 与 CW-ThuFLEP）治疗良性前列腺增生的围手术期和早期结果。

方法

238 例因良性前列腺增生导致下尿路症状的患者接受 PW-ThuFLEP（118 例）或 CW-ThuFLEP（120 例）治疗。记录术前前列腺体积、腺瘤体积、前列腺特异性抗原（PSA）和血红蛋白值。评估国际前列腺症状评分（IPSS）、最大尿流率（Qmax）、残余尿量和国际勃起功能指数-5 评分（IIEF-5）。记录手术时间、剜除时间、剜除效率、导尿时间、冲洗量、住院时间、血红蛋白下降量和术后并发症。术后 3 个月评估排尿改善和性功能结果。

结果

CW-ThuFLEP 组的手术时间更短（61.5 分钟比 67.4 分钟，P=0.04）。剜除时间（50.2 分钟比 53.3 分钟，P=0.12）、剜除效率（0.8 克/分钟比 0.7 克/分钟，P=0.38）、导尿时间（2.2 天比 2.1 天，P=0.29）、冲洗量（32.9 升比 32.8 升，P=0.71）、住院时间（2.8 天比 2.6 天，P=0.29）和血红蛋白下降量（0.38 克/分升比 0.39 克/分升，P=0.53）差异无统计学意义。并发症发生率无显著差异。在 3 个月随访时，两组在 IPSS、Qmax、残余尿量、IIEF-5 和 PSA 值方面均无显著差异。