一项比较视觉激光消融术和经尿道前列腺汽化术治疗良性前列腺增生的随机研究。

A randomized study comparing visual laser ablation and transurethral evaporation of prostate in the management of benign prostatic hyperplasia.

作者信息

Narayan P, Tewari A, Aboseif S, Evans C

机构信息

University of Florida School of Medicine, Gainesville, USA.

出版信息

J Urol. 1995 Dec;154(6):2083-8.

PMID:7500464

Abstract

PURPOSE

We evaluated the safety, efficacy, failure and complications of 2 techniques of laser prostatectomy for benign prostatic hyperplasia (BPH): transurethral evaporation of the prostate (evaporation) versus visual laser ablation of the prostate (coagulation) in a randomized trial.

MATERIALS AND METHODS

A total of 64 consecutive patients with symptomatic BPH was randomized to undergo evaporation (32) or coagulation (32). American Urological Association symptom score, peak urinary flow rate and post-void residual urine volume were measured at baseline, and at 1, 3, 6 and 12 months. Other parameters evaluated included prostate volume by transrectal ultrasound, total laser energy per patient and per cc volume of the prostate, number of laser fibers per prostate, duration of catheterization and hospitalization, need for re-catheterization, and failure and complication rates.

RESULTS

Our main findings were that patients undergoing laser prostatectomy using the coagulation technique (visual laser ablation of the prostate) had higher reoperation rates (16% versus 0%, p = 0.0199) and were 4 times more likely to have prolonged postoperative urinary retention (25% versus 6.3%, p = 0.0389), evaporation and coagulation were effective at relieving symptoms of prostatism with significant improvement in American Urological Association symptom scores and post-void residual urine volumes compared to baseline, improvement in peak flow rates was significantly greater in patients undergoing evaporation at 1, 3, 6 and 12 months (p < 0.001) compared to coagulation, and a significantly greater amount of laser energy was required to evaporate a unit volume of prostate tissue compared to coagulation (2,251 J./cc versus 1,036 J./cc, p < 0.03).

CONCLUSIONS

Between the 2 major techniques of laser prostatectomy, transurethral evaporation is associated with better results at up to 12 months of followup.

摘要

目的

在一项随机试验中，我们评估了两种用于良性前列腺增生（BPH）的激光前列腺切除术技术的安全性、有效性、失败率及并发症：经尿道前列腺汽化术（汽化）与直视激光前列腺切除术（凝固）。

材料与方法

共有64例有症状的BPH患者被随机分为接受汽化术（32例）或凝固术（32例）。在基线时以及术后1、3、6和12个月测量美国泌尿外科学会症状评分、最大尿流率和排尿后残余尿量。评估的其他参数包括经直肠超声测量的前列腺体积、每位患者及每立方厘米前列腺组织的总激光能量、每个前列腺的激光纤维数量、导尿和住院时间、再次导尿的需求以及失败率和并发症发生率。

结果

我们的主要发现是，采用凝固术（直视激光前列腺切除术）进行激光前列腺切除术的患者再次手术率更高（16% 对0%，p = 0.0199），术后出现长时间尿潴留的可能性高出4倍（25% 对6.3%，p = 0.0389）；汽化术和凝固术在缓解前列腺增生症状方面均有效，与基线相比，美国泌尿外科学会症状评分和排尿后残余尿量有显著改善；在术后1、3、6和12个月，接受汽化术的患者最大尿流率的改善明显大于接受凝固术的患者（p < 0.001）；与凝固术相比，汽化单位体积前列腺组织所需的激光能量明显更多（2251焦耳/立方厘米对1036焦耳/立方厘米，p < 0.03）。