Department of Urology, University Hospital of Tours, 2 Boulevard Tonnellé, Tours, Loire Valley, France.
World J Urol. 2024 Jul 21;42(1):422. doi: 10.1007/s00345-024-05128-5.
characterize delayed hematuria (DH) after photoselective vaporization of the prostate (PVP) and identify its associated risk factors.
1014 patients who underwent PVP at an expert center, from September 2005 through December 2021, were prospectively enrolled in a database registry. Risk factors of DH included age, prostate volume, ASA score, history of BPH surgery, history of prostate cancer, use of anticoagulation or 5ARIs, concomitant procedure, operative factors, and the duration of follow-up.
The median operating time was 60 ± 11 min. The median specific applied energy was 318,500 Joules ± 101,347. After PVP, the mean catheterization duration was 1.6 days with a postoperative hospitalization time of 1.8 days. The median follow-up was 52 months (range 2-95 months). Hematuria occurred in 206 patients (20.3%), with 10% requiring an ER visit and 8.3% requiring hospital admission, transfusion or endoscopic clot removal. Almost 80% of hematuria episodes occurred within the first 3 months. The overall retreatment rate for clot retention was 3.7% after a mean time of 50 months. Hematuria-free survival was 97.2% after 1 year, and 89.3% after 4 years. Delayed hematuria occurred in 32 patients (3.1%). In the multivariate analysis, age, preoperative prostate volume, anticoagulant use, total applied energy, lasing time and operative time were identified as risk factors for delayed hematuria after PVP.
Larger prostate volume, longer operative time, longer lasing time, and use of oral anticoagulation increase the odds of delayed hematuria after PVP, while older age is protective.
描述前列腺绿激光汽化术（PVP）后延迟性血尿（DH）的特征，并确定其相关的危险因素。
2005 年 9 月至 2021 年 12 月，在一家专家中心前瞻性地招募了 1014 例行 PVP 的患者，纳入数据库登记。DH 的危险因素包括年龄、前列腺体积、ASA 评分、BPH 手术史、前列腺癌史、抗凝或 5ARI 使用、伴随手术、手术因素以及随访时间。
中位手术时间为 60±11 分钟。中位特定应用能量为 318500 焦耳±101347 焦耳。PVP 后，平均导管留置时间为 1.6 天，术后住院时间为 1.8 天。中位随访时间为 52 个月（范围 2-95 个月）。206 例患者（20.3%）发生血尿，10%需要急诊就诊，8.3%需要住院、输血或内镜下血块清除。近 80%的血尿发作发生在术后 3 个月内。平均时间为 50 个月后，血块残留的总体再治疗率为 3.7%。1 年后血尿无复发率为 97.2%，4 年后为 89.3%。32 例患者（3.1%）发生迟发性血尿。多变量分析显示，年龄、术前前列腺体积、抗凝药物使用、总应用能量、激光时间和手术时间是 PVP 后发生迟发性血尿的危险因素。
较大的前列腺体积、较长的手术时间、较长的激光时间以及口服抗凝药物的使用增加了 PVP 后发生迟发性血尿的可能性，而年龄较大则具有保护作用。
