Ahmed M, Bell T, Lawrence W T, Ward J P, Watson G M
Eastbourne District General Hospital, UK.
Br J Urol. 1997 Feb;79(2):181-5. doi: 10.1046/j.1464-410x.1997.02667.x.
To compare transurethral microwave thermotherapy (TUMT) with urethral cooling in a high-energy protocol (Prostatron version 2.5), with transurethral resection of the prostate (TURP) for the treatment of symptomatic, uncomplicated, urodynamically obstructive benign prostatic hyperplasia (BPH).
Patients with moderate to severe symptomatic, uncomplicated BPH, unequivocally obstructed as assessed from the Abrams-Griffith nomogram, who were technically suitable for either form of treatment, were randomized into two groups of 30 patients each to undergo either TUMT or TURP. Five efficacy variables, i.e. the American Urological Association (AUA) symptom score, maximum flow rate (Qmax), post-void residual urine volume (PVR), voiding pressure at maximal flow (Pdet max) and prostatic volume determined by ultrasonography (PV) were measured initially and 6 months after treatment using a defined protocol. Complications were recorded during and up to 6 months after the treatment. As the variables were independent, the data were analysed using a paired t-test for each to assess the treatment effect for each group.
After TURP, all the variables improved significantly; after TUMT, the symptoms improved both clinically and statistically (P < 0.001), with the mean AUA symptom score decreasing from 18.4 to 5.2. However, none of the objective variables improved after TUMT. The energy delivered under software control correlated poorly with prostatic volume (r = 0.322). TUMT had considerably lower morbidity than TURP, but failure of ejaculation occurred in four of 18 sexually active men after TUMT.
Despite considerable improvement in their symptoms, TUMT using the Prostatron and Prostasoft v2.5 did not alleviate obstruction in patients with BPH. Patients treated using TUMT controlled by this software should be informed of the possibility of ejaculatory dysfunction.
比较经尿道微波热疗（TUMT）与高能方案（Prostatron 2.5版）尿道冷却以及经尿道前列腺切除术（TURP）治疗有症状、无并发症、尿动力学梗阻性良性前列腺增生（BPH）的效果。
根据Abrams-Griffith列线图评估为中度至重度有症状、无并发症且明确梗阻的BPH患者，在技术上适合两种治疗方式中的任何一种，将其随机分为两组，每组30例，分别接受TUMT或TURP治疗。使用既定方案在治疗初始及治疗后6个月测量五个疗效变量，即美国泌尿外科学会（AUA）症状评分、最大尿流率（Qmax）、排尿后残余尿量（PVR）、最大尿流时的排尿压力（Pdet max）以及通过超声检查确定的前列腺体积（PV）。在治疗期间及治疗后6个月记录并发症。由于这些变量相互独立，对每组数据采用配对t检验进行分析，以评估各治疗组的治疗效果。
TURP后，所有变量均有显著改善；TUMT后，症状在临床和统计学上均有改善（P < 0.001），AUA症状评分均值从18.4降至5.2。然而，TUMT后客观变量均未改善。软件控制下输送的能量与前列腺体积的相关性较差（r = 0.322）。TUMT的发病率远低于TURP，但18名有性生活的男性中有4人在TUMT后出现射精功能障碍。
尽管使用Prostatron和Prostasoft v2.5进行TUMT可使患者症状有显著改善，但并未缓解BPH患者的梗阻情况。应告知使用该软件控制的TUMT治疗的患者有发生射精功能障碍的可能性。
