钬激光前列腺切除术与钕：钇铝石榴石可视激光前列腺消融术：两种激光前列腺切除术技术的随机前瞻性比较

Holmium laser resection of the prostate versus neodymium:yttrium-aluminum-garnet visual laser ablation of the prostate: a randomized prospective comparison of two techniques for laser prostatectomy.

作者信息

Gilling P J, Cass C B, Malcolm A, Cresswell M, Fraundorfer M R, Kabalin J N

机构信息

Department of Urology, Tauranga Hospital, New Zealand.

出版信息

Urology. 1998 Apr;51(4):573-7. doi: 10.1016/s0090-4295(97)00642-0.

DOI:10.1016/s0090-4295(97)00642-0

PMID:9586609

Abstract

OBJECTIVES

To directly compare holmium laser resection of the prostate (HoLRP) with neodymium:yttrium-aluminum-garnet visual laser ablation of the prostate (VLAP), which represent two fundamentally different methods of laser prostatectomy.

METHODS

In a randomized, prospective comparison, a total of 44 men with symptomatic benign prostatic hyperplasia (BPH) were treated with either HoLRP or VLAP. Standard preoperative assessment included American Urological Association (AUA) symptom score, peak urinary flow rates (Qmax), ultrasound prostate volume, and residual urine measurements. Pressure-flow urodynamics were performed preoperatively and at 3 months postoperatively. Intraoperative and perioperative factors were assessed. The patients were followed at 1, 3, 6, and 12 months following the procedure.

RESULTS

There were no significant differences between the patient groups for any preoperative parameter. The mean total operating time was longer in the HoLRP group (52 minutes) compared with the VLAP group (41 minutes) (P <0.01). The mean catheter times were 1.4 days (HoLRP) and 11.6 days (VLAP) (P <0.001). These times included the 9% of patients undergoing HoLRP and 36% of patients undergoing VLAP who required recatheterization. Immediate postoperative dysuria scores were higher in the VLAP group compared with the HoLRP group. There were no significant differences in AUA scores between the two treatment groups at any postoperative interval. The Qmax values were greater at follow-up in the HoLRP group, but statistical significance was not achieved at 12 months. However, both PdetQmax and Schäfer grade measurements taken at 3 months postoperatively were significantly lower in the patients undergoing HoLRP. Three patients (14%) required reoperation in the VLAP treatment arm but no patient who underwent HoLRP has required reoperation to date.

CONCLUSIONS

HoLRP results in significantly improved patient outcomes compared to VLAP.

摘要

目的

直接比较钬激光前列腺切除术（HoLRP）与钕：钇铝石榴石可视激光前列腺消融术（VLAP），这是两种根本不同的激光前列腺切除术方法。

方法

在一项随机、前瞻性比较研究中，共有44例有症状的良性前列腺增生（BPH）男性患者接受了HoLRP或VLAP治疗。标准的术前评估包括美国泌尿外科学会（AUA）症状评分、最大尿流率（Qmax）、超声前列腺体积和残余尿量测量。术前和术后3个月进行压力-流率尿动力学检查。评估术中及围手术期因素。术后1、3、6和12个月对患者进行随访。

结果

各患者组的任何术前参数均无显著差异。HoLRP组的平均总手术时间（52分钟）比VLAP组（41分钟）长（P<0.01）。平均导尿管留置时间分别为1.4天（HoLRP）和11.6天（VLAP）（P<0.001）。这些时间包括需要再次留置导尿管的HoLRP患者中的9%和VLAP患者中的36%。VLAP组术后即刻尿痛评分高于HoLRP组。两个治疗组在任何术后时间间隔的AUA评分均无显著差异。HoLRP组随访时的Qmax值更高，但在12个月时未达到统计学显著性。然而，术后3个月进行的PdetQmax和Schäfer分级测量在接受HoLRP治疗的患者中显著更低。VLAP治疗组有3例患者（14%）需要再次手术，但迄今为止接受HoLRP治疗的患者中没有需要再次手术的。