Lorenzoni Valentina, Palla Ilaria, Manenti Guglielmo, Ditonno Pasquale, de Reijke Theo M, Turchetti Giuseppe
Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy.
Department of Diagnostic Imaging and Interventional Radiology, PTV, Rome, Italy.
Front Urol. 2023 Feb 24;3:1100386. doi: 10.3389/fruro.2023.1100386. eCollection 2023.
Benign prostatic hyperplasia (BPH) is a common diagnosis among the ageing male population over 60 years and it is associated with the development of lower urinary tract symptoms (LUTS): dysuria, nocturia, increased frequency of urination, etc. LUTS negatively affect the patient's daily activities and the quality of life. Patients with severe and persisting symptoms, not responding to pharmacological therapy, are candidates for surgical intervention. Transurethral resection of the prostate (TURP) has been the gold standard for surgical approach despite it can be associated with significant complications. Indeed, laser vaporization or enucleation are today the most broadly used surgical techniques and other minimally invasive surgical therapies (MISTs) have been introduced to reduce some complications during- and post-surgery. Moreover, a new micro-invasive approach for LUTS is represented by EchoLaser SoracteLite™ transperineal laser ablation (TPLA), an innovative, safe and feasible approach that can be performed under local anaesthesia and in an outpatient setting.
The paper aims to analyse and discuss the economic implications of standard surgical techniques and innovative approaches with a focus on TPLA thought a literature review.
The literature review highlights that at present there are few studies related to the economic implications of surgical therapies for LUTS. Preliminary results show that the TPLA is a promising technique in terms of clinical and economic benefit for the treatment of obstructive LUTS. Furthermore, TPLA can be performed in an outpatient setting implying an advantage from an economic and also organizational point of view, in particular in a health emergency situation.
Economic literature on minimally invasive techniques and surgical approaches for the treatment of BPH is still lacking. Multicentre and long-term economic studies are needed to assess the estimated disease burden. However, direct and indirect costs associated with TPLA are minimized vs TURP and laser vaporization/enucleation.
良性前列腺增生（BPH）是60岁以上老年男性的常见诊断疾病，它与下尿路症状（LUTS）的发生有关，如下尿痛、夜尿、尿频等。下尿路症状会对患者的日常活动和生活质量产生负面影响。症状严重且持续、对药物治疗无反应的患者是手术干预的候选对象。经尿道前列腺切除术（TURP）一直是手术治疗的金标准，尽管它可能会伴有严重并发症。事实上，激光汽化或剜除术如今是最广泛使用的手术技术，并且已经引入了其他微创外科治疗方法（MISTs）以减少手术期间及术后的一些并发症。此外，一种治疗下尿路症状的新型微创方法是EchoLaser SoracteLite™经会阴激光消融术（TPLA），这是一种创新、安全且可行的方法，可在局部麻醉下于门诊进行。
本文旨在通过文献综述分析和讨论标准手术技术及创新方法的经济影响，重点关注TPLA。
文献综述表明，目前关于下尿路症状手术治疗经济影响的研究较少。初步结果显示，就治疗梗阻性下尿路症状的临床和经济效益而言，TPLA是一种有前景的技术。此外，TPLA可在门诊进行，这在经济和组织层面都具有优势，尤其是在突发卫生事件情况下。
关于治疗良性前列腺增生的微创技术和手术方法的经济文献仍然匮乏。需要进行多中心和长期的经济研究来评估估计的疾病负担。然而，与经尿道前列腺切除术以及激光汽化/剜除术相比，TPLA相关的直接和间接成本降至最低。
