经会阴前列腺激光消融术治疗高危前列腺增生患者严重下尿路症状
Trans - Perineal laser ablation of the prostate in high surgical risk patients affected by severe lower urinary tract symptoms related to benign prostatic obstruction.
机构信息
Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy.
Urology Unit, Ospedale Sant'Andrea, La Sapienza University of Rome, Rome, Italy.
出版信息
Prostate Cancer Prostatic Dis. 2024 Dec;27(4):693-699. doi: 10.1038/s41391-023-00736-5. Epub 2023 Oct 18.
BACKGROUND
In our study, we aimed to test the efficacy and safety of Trans-Perineal Laser Ablation of the prostate (TPLA®) in the surgical treatment of high-risk Benign Prostatic Obstruction (BPO) patients.
METHODS
We defined a high-risk BPO patient as an elderly man affected by severe comorbidities, among which coagulation issues due to pre-existent medications or diseases. From October 2020 to June 2022, we prospectively enrolled high-risk patients affected by a moderate to severe and/or complicated BPO condition. The analysis of the efficacy of the Trans-Perineal Laser Ablation was defined as the primary endpoint of the study. Secondary endpoints were post-operative surgical complications and patient-reported quality of life.
RESULTS
Globally, 40 consecutive patients were enrolled. Median (IQR) age was 80 (72.5-84) years. Median Charlson Comorbidity Index was 6 (5-7). Median prostate volume was 38 (30.5-73) cc. In all cases, a TPLA® procedure was performed under local anesthesia, and patients being discharged within the same day of the procedure. A progressive reduction of median prostate volumes was reported at 3 and 6 months post-operatively, compared to baseline [38 (30.5-73) vs 35 (26-49) vs 34 (28-49) cc, p < 0.001]. Median International Prostate Symptom Score (IPSS) improved accordingly [25 (19-30) vs 10.5 (7.5-13) vs 8 (6-11.5), p < 0.001]. A permanent bladder catheter was successfully removed in 13 out of 23 (56.5%) cases. Within 90 days from surgery, 19 (47.5%) patients experienced at least one surgical complication. According to the Clavien-Dindo classification, complications were classified as grade I in 16 (40%) cases, grade II in 9 (22.5%), and grade III in 1 (2.5%). We did not observe any grade IV or V complications.
CONCLUSIONS
The Trans-Perineal Laser Ablation of the Prostate is a feasible, safe, and effective Minimally Invasive Surgical Technique, when offered to elderly, high-risk patients affected by severe Benign Prostatic Obstruction.
背景
在我们的研究中，我们旨在测试经会阴激光前列腺消融术（TPLA®）在治疗高危良性前列腺增生（BPO）患者中的疗效和安全性。
方法
我们将高危 BPO 患者定义为患有严重合并症的老年男性，其中包括由于先前的药物或疾病引起的凝血问题。从 2020 年 10 月至 2022 年 6 月，我们前瞻性地招募了患有中重度和/或复杂 BPO 疾病的高危患者。经会阴激光前列腺消融术的疗效分析被定义为研究的主要终点。次要终点是术后手术并发症和患者报告的生活质量。
结果
总共纳入了 40 名连续患者。中位（IQR）年龄为 80（72.5-84）岁。中位 Charlson 合并症指数为 6（5-7）。中位前列腺体积为 38（30.5-73）cc。在所有情况下，均在局部麻醉下进行 TPLA®手术，患者在手术当天出院。与基线相比，术后 3 个月和 6 个月时报告的中位前列腺体积逐渐减少[38（30.5-73）vs 35（26-49）vs 34（28-49）cc，p<0.001]。国际前列腺症状评分（IPSS）相应改善[25（19-30）vs 10.5（7.5-13）vs 8（6-11.5），p<0.001]。23 例（56.5%）患者中成功去除永久性膀胱导管。术后 90 天内，19 例（47.5%）患者至少发生 1 例手术并发症。根据 Clavien-Dindo 分类，并发症在 16 例（40%）患者中为 I 级，在 9 例（22.5%）患者中为 II 级，在 1 例（2.5%）患者中为 III 级。我们未观察到任何 IV 级或 V 级并发症。
结论
经会阴激光前列腺消融术是一种可行、安全且有效的微创外科技术，适用于患有严重良性前列腺增生的高危老年患者。
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