Gerber G S, Jahoda A, Bales G T, Albala D M
Department of Surgery, University of Chicago Pritzker, School of Medicine, Illinois, USA.
Tech Urol. 1997 Spring;3(1):25-9.
Transurethral vaporization of the prostate (TVAP) is a new technique for the surgical treatment of men with benign prostatic hyperplasia (BPH). The primary advantage of TVAP appears to be shortened hospitalization and less bleeding than is associated with transurethral resection of the prostate (TURP). Since February 1995, 66 consecutive men with bladder outlet obstruction (47 with persistent voiding symptoms and 19 in complete urinary retention) secondary to prostatic disease underwent TVAP at two university hospitals. TVAP was utilized in all patients regardless of prostate size. The mean length of follow-up was 3.2 months. All 19 men in complete retention were able to void adequately following surgery with a mean postvoid residual volume of 18cc and a mean International Prostate Symptom Score (I-PSS) of 7.5. In the remaining patients, the I-PSS decreased from a mean of 19.6 to 8.4. Pre- and postoperative peak urinary flow rate data were available in 17 men and increased from 9 to 18 cc/s. Limited transurethral resection of prostatic tissue at the completion of TVAP was necessary to adequately relieve bladder outlet obstruction in 18% (12/66) of patients. Hospitalization of < 24 h was needed in 68% (45/66) patients. The urinary catheter was removed within 1 day of surgery in 68% (45/66) of men as well. Seven patients required catheter replacement postoperatively due to difficulty voiding (five men) or bleeding (two men). No patient required blood transfusion. TVAP is effective in relieving bladder outlet obstruction in men with and without urinary retention. The majority of patients require brief or no hospitalization and are able to void adequately within 24 h of surgery. TVAP appears to be less effective in men with large prostate glands, and limited TURP is more frequently needed in these cases. The long-term results of TVAP will require further study.
经尿道前列腺汽化术（TVAP）是一种治疗良性前列腺增生（BPH）男性患者的新技术。TVAP的主要优点似乎是与经尿道前列腺切除术（TURP）相比，住院时间缩短且出血更少。自1995年2月以来，两所大学医院连续对66例因前列腺疾病导致膀胱出口梗阻的男性患者（47例有持续性排尿症状，19例完全尿潴留）进行了TVAP治疗。所有患者无论前列腺大小均采用TVAP。平均随访时间为3.2个月。所有19例完全尿潴留的男性患者术后均能充分排尿，平均残余尿量为18cc，平均国际前列腺症状评分（I-PSS）为7.5。其余患者的I-PSS从平均19.6降至8.4。17例男性患者有术前和术后的最大尿流率数据，其最大尿流率从9cc/s增至18cc/s。在TVAP完成时，18%（12/66）的患者需要进行有限的经尿道前列腺组织切除术以充分解除膀胱出口梗阻。68%（45/66）的患者住院时间<24小时。68%（45/66）的男性患者在术后1天内拔除了导尿管。7例患者术后因排尿困难（5例男性）或出血（2例男性）需要更换导尿管。无患者需要输血。TVAP对有或无尿潴留的男性患者缓解膀胱出口梗阻均有效。大多数患者需要短暂住院或无需住院，且能在术后24小时内充分排尿。TVAP对前列腺较大的男性患者似乎效果较差，在这些病例中更常需要进行有限的TURP。TVAP的长期结果需要进一步研究。
