Fournier G R, Tewari A, Induhara R, Gajenderan V, Narayan P
Department of Veterans Affairs, Division of Urology, San Francisco, California 94121, USA.
Lasers Surg Med. 1996;19(4):480-6. doi: 10.1002/(SICI)1096-9101(1996)19:4<480::AID-LSM15>3.0.CO;2-6.
Little information is available regarding the effectiveness of laser prostatectomy in patients with urinary retention from benign prostatic hyperplasia since there is no paper specifically dealing with laser prostatectomy in patients in urinary retention.
STUDY DESIGN/MATERIALS AND METHODS: Twenty two unselected consecutive patients presenting with urinary retention due to benign prostatic hypertrophy underwent transurethral evaporation of the prostate (TUEP) using a neodymium:YAG laser and total internally reflecting side-firing free beam quartz fiber. All patients failed at least one voiding trial and averaged > 30 days of urinary catheter drainage preoperatively. A contact evaporation technique was used to evaporate a "TURP-like" channel in the prostatic fossa by means of a series of parallel evaporation troughs.
Eighteen of 22 patients completed 6 months of follow up. Two patients were lost to follow up and two failed TUEP. The average AUA score dropped from 26 to 9 at 1 month and to 3.4 by 6 months postoperatively. All patients who successfully underwent TUEP were urinating spontaneously by 10 days. Average time to catheter removal was 3.5 days. Maximal uroflow was 15.7 ml/sec at 1 month and 20.3 ml/sec by 6 months. Postvoid residual preoperatively averaged 784 ml and decreased to 76 ml by 1 month. Pre- and postoperative hematocrit and serum sodium values did not vary by more than 5%.
From this preliminary series we conclude that aggressive evaporation of prostatic tissue is feasible endoscopically and provides a reliable method of near bloodless removal of tissue.
关于激光前列腺切除术对良性前列腺增生所致尿潴留患者的有效性，目前可获取的信息较少，因为尚无专门针对尿潴留患者进行激光前列腺切除术的文献。
研究设计/材料与方法：22例因良性前列腺肥大出现尿潴留的连续患者，未经过挑选，采用钕:钇铝石榴石激光及全内反射侧向发射自由光束石英纤维行经尿道前列腺汽化术（TUEP）。所有患者至少一次排尿试验失败，术前平均导尿引流时间超过30天。采用接触汽化技术，通过一系列平行的汽化槽在前列腺窝内汽化出一条“经尿道前列腺切除术（TURP）样”通道。
22例患者中有18例完成了6个月的随访。2例患者失访，2例TUEP手术失败。术后1个月美国泌尿外科学会（AUA）平均评分从26降至9，术后6个月降至3.4。所有成功接受TUEP手术的患者在10天时均能自主排尿。平均拔管时间为3.5天。术后1个月最大尿流率为15.7毫升/秒，术后6个月为20.3毫升/秒。术前平均残余尿量为784毫升，术后1个月降至76毫升。术前和术后的血细胞比容及血清钠值变化不超过5%。
从这个初步系列研究中我们得出结论，积极地汽化前列腺组织在内窥镜下是可行的，并且提供了一种可靠的几乎无血的组织切除方法。
