Department of Urology, Tianjin Union Medical Center, Tianjin, China.
Photobiomodul Photomed Laser Surg. 2024 Nov;42(11):708-715. doi: 10.1089/pho.2024.0056. Epub 2024 Jul 30.
To evaluate the safety and efficacy of 180-W XPS Greenlight laser "Five-step" photoselective vaporization of the prostate (PVP) in patients with benign prostatic hyperplasia (BPH) with prostate volume (PV) > 80 mL. In patients with BPH with large PV, PVP often results in bleeding, unclear visual field, additional damage, and insufficient tissue vaporization. This single-center, retrospective study enrolled patients with BPH with PV > 80 mL treated with the Five-step PVP or the Conventional PVP from January 2018 to June 2021. Comorbidities, high-risk habits, and operative parameters were analyzed and compared. The short-term functional outcomes and postoperative complications were recorded over the 24-month follow-up. Two hundred eligible patients were divided into the Five-step PVP and Conventional PVP groups ( = 100 each). These groups showed no differences in comorbidities, living habits, baseline perioperative parameters, operative time, lasing time, or energy use. However, a higher energy density (3.95 [interquartile range (IQR) 3.37, 4.52] vs 3.68 [IQR 3.17, 4.20] kJ/mL) and energy-time ratio (7.23 [IQR 6.12, 8.52] vs 6.72 [IQR 5.51, 7.87] kj/min = 0.034) were obtained in the Five-step PVP group. Subgroup analysis of patients with PV ≥120 mL showed similar results. The short-term functional outcomes were similar between the two study groups with significant improvement from baseline, but the total prostate-specific antigen levels at 1 and 6 months were lower in the Five-step PVP group. Further, incidences of intraoperative bleeding, bladder mucosa injury, postoperative hematuria, and urinary tract infection were lower in the Five-step PVP group. In the Conventional PVP group, four patients required conversion to transurethral resection of the prostate in surgery and two patients required retreatment during the 24-month follow-up. The 180-W XPS Greenlight laser Five-step PVP has advantages of less bleeding, high vaporization efficiency, and low rates of perioperative complications, and, therefore, it is a promising treatment to improve short-term functional outcomes for patients with BPH with large PV.
评估 180W XPS 绿光激光前列腺体积（PV）>80ml 的良性前列腺增生（BPH）患者的五步选择性光汽化术（PVP）的安全性和有效性。对于 PV 较大的 BPH 患者，PVP 常导致出血、视野不清、额外损伤和组织汽化不足。这项单中心回顾性研究纳入了 2018 年 1 月至 2021 年 6 月接受五步 PVP 或常规 PVP 治疗的 PV>80ml 的 BPH 患者。分析比较了合并症、高危习惯和手术参数。记录了 24 个月随访期间的短期功能结果和术后并发症。200 名符合条件的患者被分为五步 PVP 和常规 PVP 组（每组 100 名）。两组在合并症、生活习惯、围手术期基线参数、手术时间、激光时间或能量使用方面无差异。然而，五步 PVP 组的能量密度（3.95[四分位距（IQR）3.37，4.52] vs 3.68[IQR 3.17，4.20]kJ/ml）和能量时间比（7.23[IQR 6.12，8.52] vs 6.72[IQR 5.51，7.87]kJ/min=0.034）更高。PV≥120ml 患者的亚组分析也得到了类似的结果。两组患者的短期功能结果相似，与基线相比均有显著改善，但五步 PVP 组的总前列腺特异性抗原水平在 1 个月和 6 个月时较低。此外，五步 PVP 组术中出血、膀胱黏膜损伤、术后血尿和尿路感染的发生率较低。在常规 PVP 组，4 例患者在手术中需要转为经尿道前列腺电切术，2 例患者在 24 个月随访期间需要再次治疗。180W XPS 绿光激光五步 PVP 具有出血少、汽化效率高、围手术期并发症发生率低等优点，因此是改善 PV 较大的 BPH 患者短期功能的一种有前途的治疗方法。
