Photoselective vaporization of the prostate in the treatment of benign prostatic hyperplasia.
Photoselective vaporization of the prostate in the treatment of benign prostatic hyperplasia.
复制标题
前列腺光选择性汽化治疗良性前列腺增生。
作者：
W. Fu;B. Hong;Yong Yang;W. Cai;Jiang;Chun;Xiao
背景
对大多数泌尿外科医生来说，有症状的良性前列腺增生症(BPH)的治疗仍然是一个挑战。我们研究了接受选择性前列腺汽化术(PVP)的症状性良性前列腺增生症(BPH)患者的累积队列，并评估了该手术的有效性和安全性。
方法
对196例继发于BPH的下尿路梗阻患者，在骶管麻醉下采用激光前列腺汽化术治疗。采用以下指标评价治疗效果：骶管麻醉的安全性和有效性、出血量、手术时间、留置导尿术。以国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)、排尿后残余尿量(PVR)及性功能变化作为评价指标。患者还接受了3个月的随访评估。
结果
所有患者均顺利完成PVP手术。腰麻195例，硬膜外麻醉1例。平均手术时间(45.2±18.5)分钟。术后平均IPSS由(2 6.6±-3.2)分降至(5.6±-1.4)分，生活质量评分由(5.7±-0.4)分降至(1.6+/-0.5)分(P<0.0 5)，Qmax由(6.7±-2.5)ml/S升至(19.6±-2.4)ml/S，PVR由158.4降至2 5.8ml(P<；0.0 5)。平均导尿时间为(1.8±0.9)d。术中无明显失血或液体吸收。并发症包括一过性排尿困难3例(1.5%)，迟发性肉眼血尿5例(2.5%)。早在PVP治疗后3个月，临床结果就有显著改善。
结论
PVP被患者认为是一种高满意率和最小的术后并发症。因此，PVP是治疗症状性前列腺增生症的一种新颖、安全、有效、微创的治疗方法。
BACKGROUND
The treatment of symptomatic benign prostatic hyperplasia (BPH) remains a challenge for most urologic surgeons. We studied a cumulative cohort of patients with symptomatic benign prostatic hyperplasia (BPH) who underwent photoselective vaporization of the prostate (PVP) and evaluated the efficacy and safety of this procedure.
METHODS
A total of 196 patients with lower urinary tract obstruction symptoms secondary to BPH were treated using laser vaporization of the prostate under sacral canal anesthesia at our institutions. The therapeutic results were assessed using following variables: the safety and efficacy of sacral anesthesia, blood loss, operative time, indwelling catheterization. Preoperative and perioperative parameters were evaluated in the international prostate symptom score (IPSS), quality of life score (QoL), maximal urinary flow rate (Qmax), post-void residual urine volume (PVR) and the change of sexual function. Patients were also assessed for 3-month follow up.
RESULTS
PVP was performed successfully for all patients. There were 195 patients under sacral anesthesia and 1 patient under epidural anesthesia. Mean operative time was (45.2 +/- 18.5) minutes. The mean IPSS decreased from (26.6 +/- 3.2) to (5.6 +/- 1.4) and the QoL score decreased from (5.7 +/- 0.4) to (1.6 +/- 0.5), respectively (P < 0.05), while mean Qmax increased from (6.7 +/- 2.5) ml/s preoperatively to (19.6 +/- 2.4) ml/s, PVR decreased from 158.4 to 25.8 ml, respectively (P < 0.05). Average catheterization time was (1.8 +/- 0.9) days. There was no significant blood loss or fluid absorption during the period of PVP. Complications consisted of transient dysuria in 3 patients (1.5%), delayed gross hematuria in 5 patients (2.5%), respectively. Significant improvement in clinical outcomes were noted as early as 3 months after PVP treatment.
CONCLUSIONS
PVP is considered as a high satisfaction rate by patient and a minimal postoperative complication. Hence, PVP is a novel, safe, effective and minimal invasive treatment for patients with symptomatic BPH.