Flanigan R C, Reda D J, Wasson J H, Anderson R J, Abdellatif M, Bruskewitz R C
Cooperative Studies Program of the Research and Development Service, Department of Veterans Affairs, Hines, Illinois, USA.
J Urol. 1998 Jul;160(1):12-6; discussion 16-7.
We determine outcomes after 5 years of followup for men who were randomized to receive transurethral resection or watchful waiting for moderate symptoms of benign prostatic hyperplasia.
A total of 556 patients were evaluated up to 60 months after randomization providing 966 patient-years of followup for transurethral prostatic resection and 990 for watchful waiting. Patients randomized to watchful waiting were evaluated according to whether they remained on treatment or crossed over to surgery. Outcomes included treatment failure, a genitourinary symptom score, peak flow rate, post-void residual urine volume and the degree of bother from genitourinary symptoms.
All outcomes were significantly better for transurethral prostatic resection than for watchful waiting. Treatment failure rates were 10% for transurethral prostatic resection versus 21% for watchful waiting (p = 0.0004). The crossover rate at 5 years was 36% and was positively associated with the degree of bother. Men with low pretreatment peak flow rates who were randomized to transurethral prostatic resection had 85% greater improvement in peak flow rate than comparable men who were randomized to watchful waiting and eventually crossed over to resection. However, after crossover, bother from genitourinary symptoms was similar to that of the resection group.
For men with moderate symptoms of benign prostatic hyperplasia transurethral prostatic resection has more favorable outcomes up to 5 years of followup compared to watchful waiting. While many men do well on watchful waiting, those who undergo transurethral prostatic resection after a trial of watchful waiting have less improvement in measures of bladder function than men randomized to resection, although there is no difference in serious adverse outcomes or bother from genitourinary symptoms.
我们对随机接受经尿道前列腺切除术或等待观察治疗中度良性前列腺增生症状的男性进行了5年随访，以确定其治疗结果。
共有556例患者在随机分组后接受了长达60个月的评估，经尿道前列腺切除术的随访时间为966患者年，等待观察治疗的随访时间为990患者年。随机接受等待观察治疗的患者根据其是否继续接受该治疗或转而接受手术进行评估。结果包括治疗失败、泌尿生殖系统症状评分、最大尿流率、排尿后残余尿量以及泌尿生殖系统症状的困扰程度。
经尿道前列腺切除术的所有结果均显著优于等待观察治疗。经尿道前列腺切除术的治疗失败率为10%，而等待观察治疗的失败率为21%（p = 0.0004）。5年时的交叉治疗率为36%，且与困扰程度呈正相关。随机接受经尿道前列腺切除术且术前最大尿流率较低的男性，其最大尿流率的改善程度比随机接受等待观察治疗最终转而接受切除术的类似男性高85%。然而，交叉治疗后，泌尿生殖系统症状的困扰程度与切除术组相似。
对于中度良性前列腺增生症状的男性，与等待观察治疗相比，经尿道前列腺切除术在长达5年的随访中具有更有利的结果。虽然许多男性在等待观察治疗中情况良好，但那些在经过一段时间的等待观察治疗后接受经尿道前列腺切除术的男性，其膀胱功能指标的改善程度低于随机接受切除术的男性，尽管在严重不良后果或泌尿生殖系统症状的困扰方面没有差异。
