Di Maida Fabrizio, Oriti Francesca, Grosso Antonio Andrea, Sessa Francesco, Paganelli Daniele, Salamone Vincenzo, Costagli Sara, Solazzi Francesca, Lambertini Luca, Salvi Matteo, Dio Michele Di, Mari Andrea, Oriti Rino, Minervini Andrea
Department of Experimental and Clinical Medicine, University of Florence-Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, 50134, Italy.
Department of Experimental and Clinical Medicine, University of Florence-Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, 50134, Italy.
Can J Urol. 2025 Aug 29;32(4):283-292. doi: 10.32604/cju.2025.065984.
The surgical management of patients with benign prostatic hyperplasia (BPH) has considerably evolved through recent years. Nonetheless, benefits and harms of several laser procedures are still to be determined. The study aimed to report perioperative and early functional results of patients treated with anatomical photo vaporization of the prostate (aPVP).
Data from consecutive patients treated with aPVP by using a 180-W XPS GreenLight laser were prospectively collected in a single tertiary center between 2020 and 2023. The surgical procedure was divided into a modular step-by-step fashion. Patients were asked to complete self-administered questionnaires at baseline and during follow-up visits.
Overall, 176 consecutive patients were enrolled. Median age was 65 [interquartile range (IQR) 63-72] years. The baseline median prostate volume was 61.2 (IQR 52.5-71.0) mL, and the median max flow rate (Q) was 9.3 (IQR 7.8-11.5) mL/s. Median preoperative International Prostate Symptom Score (IPSS) was 25 (IQR 22-29). Overall, the median operative time was 42 (IQR 31-47) minutes with a median energy/mL of tissue delivered of 2447 kJ/mL. At 3 month-evaluation, significant improvements were observed, with a median Q of 28 (IQR: 24-32) mL/s and a median IPSS reduction of 15 (IQR: 11-18) points. A strong inverse correlation was identified between energy delivery during initial procedural steps and the severity of postoperative storage symptoms (all p < 0.05), underscoring the importance of precise energy modulation. Multivariate analysis identified increased prostate volume (odds ratio [OR]: 1.02; 95% confidence interval [CI] 1.01-1.11; p = 0.001) and higher prostate width-to-length ratio (OR: 1.28; 95% CI 1.04-1.78; p = 0.03) as independent predictors of increased energy requirements.
aPVP with 180-W XPS GreenLight laser is a safe and effective technique showing worthy early functional results. The limitation of the energy delivered in some key phases of the procedure may be associated with a significant reduction in postoperative irritative symptoms. The shape and dimensions of the prostate also play a critical role in determining the total energy required for complete adenoma removal.
近年来，良性前列腺增生（BPH）患者的外科治疗方法有了很大进展。尽管如此，几种激光手术的益处和危害仍有待确定。本研究旨在报告接受前列腺解剖性光汽化术（aPVP）治疗患者的围手术期及早期功能结果。
2020年至2023年期间，在一家单一的三级中心前瞻性收集连续接受180W XPS绿激光aPVP治疗患者的数据。手术过程采用模块化的分步方式。要求患者在基线和随访期间完成自我管理的问卷调查。
总体而言，连续纳入176例患者。中位年龄为65岁[四分位间距（IQR）63 - 72岁]。基线时前列腺体积中位数为61.2（IQR 52.5 - 71.0）mL，最大尿流率（Q）中位数为9.3（IQR 7.8 - 11.5）mL/s。术前国际前列腺症状评分（IPSS）中位数为25（IQR 22 - 29）。总体而言，中位手术时间为42（IQR 31 - 47）分钟，每毫升组织输送的能量中位数为2447 kJ/mL。在3个月评估时，观察到显著改善，Q中位数为28（IQR：24 - 32）mL/s，IPSS中位数降低15（IQR：11 - 18）分。在初始手术步骤中的能量输送与术后储尿期症状的严重程度之间发现了强烈的负相关（所有p < 0.05），强调了精确能量调节的重要性。多因素分析确定前列腺体积增加（比值比[OR]：1.02；95%置信区间[CI] 1.01 - 1.11；p = 0.001）和更高的前列腺宽长比（OR：1.28；95% CI 1.04 - 1.78；p = 0.03）是能量需求增加的独立预测因素。
180W XPS绿激光aPVP是一种安全有效的技术，显示出值得肯定的早期功能结果。手术某些关键阶段能量输送的限制可能与术后刺激性症状的显著减少有关。前列腺的形状和尺寸在确定完全切除腺瘤所需的总能量方面也起着关键作用。
