Gallucci M, Puppo P, Perachino M, Fortunato P, Muto G, Breda G, Mandressi A, Comeri G, Boccafoschi C, Francesca F, Guazzieri S, Pappagallo G L
A.Ur.O. Cooperative Group Associazione Urologi Ospedalieri, Pietra Ligure, Italy.
Eur Urol. 1998;33(4):359-64. doi: 10.1159/000019616.
To evaluate clinical, urodynamic efficacy and safety of TURP and TVP in patients with symptoms due to obstructive benign prostatic hypertrophy with a prospective multicentric randomized study.
150 patients with BPH, urodynamically obstructed, were randomized to receive TURP or TVP. At the end of the recruitment phase, 80 patients underwent TURP and 70 patients underwent TVP. Patients were clinically evaluated by the I-PSS score at months 0, 1, 3, 6 and 12. Preoperative evaluation included complete blood routine examination, PSA, transrectal ultrasound and pressure/flow studies. Pressure/flow studies were also performed after 3 months.
There was no statistical difference between groups in any of the preoperative parameters. All patients were considered urodynamically obstructed at preoperative pressure studies. As for catheter days and hospitalization days, statistical differences between TVP and TURP were found; catheter days were 2.71 days (SE 0.12) in the TURP group vs. 1.9 (SE 0.24) in the TVP group (p < 0.000). Hospitalization was 4.7 days (SE 0.22) after TURP and 3.9 days (SE 0.24) after TVP (p < 0.000). Mean preoperative I-PSS score was 18.84 and 18.19 in the TVP and TURP groups, respectively. At 3, 6 and 12 months, IPSS was 5.52 and 5.50, 3.77 and 4.94, 3.52 and 4.04 for TURP and TVP, respectively. Mean preoperative peak flow rate (PFR) was 8.78 and 7.26 ml/s for TURP and TVP, respectively; after 3, 6 and 12 months, PFR was 19.21 and 18.8, 20.77 and 20.13, 20.30 and 20.31 ml/s, respectively. After 3 months, 6 patients in the TURP group (7.5%) and 7 patients in the TVP group (10%) were borderline obstructed. 1 patient in the TVP group (1.4%) was still obstructed and underwent TURP. As for complications, 4 patients (5.7%) in the TVP group had stress urinary incontinence after 12 months vs. 1 (1.25%) in the TURP group.
The present study clearly demonstrates that TVP is as effective as TURP in relieving urinary obstruction due to BPH, it offers some advantages in terms of catheterization and hospital stay, but at the price of a higher incidence of postoperative urine incontinence. Technical improvements might solve this problem in the future, perhaps combining TVP with TURP of the apical tissue.
通过一项前瞻性多中心随机研究，评估经尿道前列腺电切术（TURP）和经尿道前列腺汽化术（TVP）治疗因梗阻性良性前列腺增生导致症状的患者的临床、尿动力学疗效及安全性。
150例经尿动力学检查证实存在梗阻的良性前列腺增生（BPH）患者被随机分为接受TURP或TVP治疗。在招募阶段结束时，80例患者接受了TURP，70例患者接受了TVP。在第0、1、3、6和12个月时通过国际前列腺症状评分（I-PSS）对患者进行临床评估。术前评估包括全血常规检查、前列腺特异性抗原（PSA）、经直肠超声检查以及压力/流量研究。3个月后也进行了压力/流量研究。
术前各项参数在两组之间均无统计学差异。术前压力研究时所有患者均被认为存在尿动力学梗阻。至于导尿管留置天数和住院天数，TVP组和TURP组之间存在统计学差异；TURP组导尿管留置天数为2.71天（标准误0.12），而TVP组为1.9天（标准误0.24）（p < 0.000）。TURP术后住院时间为4.7天（标准误0.22），TVP术后为3.9天（标准误0.24）（p < 0.000）。TVP组和TURP组术前平均I-PSS评分分别为18.84和18.19。在第3、6和12个月时，TURP组和TVP组的IPSS分别为5.52和5.50、3.77和4.94、3.52和4.04。TURP组和TVP组术前平均最大尿流率（PFR）分别为8.78和7.26 ml/s；在第3、6和12个月时，PFR分别为19.21和18.8、20.77和20.13、20.30和20.31 ml/s。3个月后，TURP组有6例患者（7.5％）和TVP组有7例患者（10％）存在轻度梗阻。TVP组有1例患者（1.4％）仍存在梗阻并接受了TURP。至于并发症，TVP组有4例患者（5.7％）在12个月后出现压力性尿失禁，而TURP组为1例（1.25％）。
本研究清楚地表明，TVP在缓解BPH引起的尿路梗阻方面与TURP一样有效，在导尿和住院时间方面具有一些优势，但代价是术后尿失禁发生率较高。技术改进可能会在未来解决这个问题，也许可以将TVP与尖部组织的TURP相结合。
