Photoselective vaporization of the prostate versus green laser enucleation of the prostate for the treatment of lower urinary tract symptoms caused by benign prostatic hyperplasia: a single-center retrospective analysis
Ji Alin, Quan Jing, Huang Xinmian, Xue Wenbin, Xu Zhihui, Huang Banggao*
Department of Urology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou 310014
摘要目的： 比较选择性绿激光前列腺汽化术（PVP）与绿激光前列腺剜除术（GreenLEP）治疗良性前列腺增生（BPH）的疗效。方法： 回顾性分析2019年6月至2020年12月浙江省人民医院泌尿外科因BPH导致下尿路症状而行手术的患者274例,根据手术方式不同,分为PVP组134例和GreenLEP组 140例,比较两组患者围手术期和随访指标。结果： 两组患者均顺利完成手术,术中无前列腺包膜穿孔、尿道括约肌损伤、大出血等并发症发生。与PVP组相比,GreenLEP组手术时间[(26.79±7.71) min vs. (48.21±19.38) min]、留置导尿管时间[(3.45±0.83) d vs. (3.71±1.23) d]、膀胱冲洗时间[(1.07±0.28) d vs. (1.28±0.47) d]较PVP组短,且GreenLEP组白细胞计数[(7.16±2.27)×109/L vs. (8.01±2.11)×109/L]更少。除此以外,相较于PVP组,GreenLEP组术后1月Qmax[(21.09±1.79) ml/s vs. (20.60±1.88) ml/s]更大,尿白细胞数值[24.45(4.9, 21351.9) 个/ul vs. 35.50(5.7, 32901.9) 个/ul]和QOL评分[ (1.29±0.53) 分vs. (1.46±0.62) 分]更小,差异均具有统计学意义（P<0.05）。结论： GreenLEP相比PVP不仅缩短了手术时间,还保留了组织标本,提高了患者的术后生活质量。
Abstract：Objective： To compare the efficacy of photoselective vaporization of the prostate （PVP） and green laser enucleation of the prostate （GreenLEP） in the treatment of benign prostatic hyperplasia （BPH）. Methods： From June 2019 to December 2020, 274 patients with lower urinary tract symptoms caused by BPH in the Department of Urology of Zhejiang Provincial People’s Hospital were retrospectively analyzed. According to different surgical methods, the patients were divided into PVP group （n=134） and GreenLEP group （n=140）. The perioperative and follow-up indexes of the two groups were compared. Results： Both groups of patients successfully completed the operation. No complications such as prostatic capsule perforation, urethral sphincter injury and massive hemorrhage occurred during the operation. Compared with PVP group, GreenLEP group had shorter operation time [（26.79±7.71）min vs. （48.21±19.38）min], indwelling catheter time [（3.45±0.83）d vs.（3.71±1.23）d] and the bladder flushing time [（1.07±0.28）d vs. （1.28±0.47）d]. Besides, GreenLEP group had a less WBC count [（7.16±2.27）×109/L vs. （8.01±2.11）×109/L]. In addition, Qmax of GreenLEP group at 1 month after surgery [（21.09±1.79）mL/s vs. （20.60±1.88）ml/s] was larger andurinary leukocyte count [24.45（4.9, 21351.9）/μLvs. 35.50（5.7, 32901.9）/μL] and QOL score [（1.29±0.53） vs. （1.46±0.62）] were lower. The differences were statistically significant （P< 0.05）. Conclusion： Compared with PVP, GreenLEP can not only shorten the operation time, but also retain tissue samples and improve the quality of life of patients after operation.
纪阿林, 全晶, 黄新冕, 薛文彬, 徐智慧, 黄邦高. 选择性绿激光前列腺汽化术与绿激光前列腺剜除术治疗良性前列腺增生的疗效对比[J]. 微创泌尿外科杂志, 2022, 11(1): 32-37.
Ji Alin, Quan Jing, Huang Xinmian, Xue Wenbin, Xu Zhihui, Huang Banggao. Photoselective vaporization of the prostate versus green laser enucleation of the prostate for the treatment of lower urinary tract symptoms caused by benign prostatic hyperplasia: a single-center retrospective analysis. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2022, 11(1): 32-37.
[1] LUKACS B, CORNU JN, AOUT M, et al. Management of lower urinary tract symptoms related to benign prostatic hyperplasia in real-life practice in France: a comprehensive population study[J]. Eur Urol,2013,64(3):493-501. [2] THOMAS JA, TUBARO A, BARBER N, et al. A multicenter randomized noninferiority trial comparing GreenLight-XPS laser vaporization of the prostate and transurethral resection of the prostate for the treatment of benign prostatic obstruction: two-yr outcomes of the Goliath study[J]. Eur Urol,2016,69(1):94-102. [3] PATHAK RA, BRODERICK GA, IGEL TC, et al. Impact of minimally invasive benign prostatic hyperplasia therapies on 30- and 90-day postoperative office encounters[J]. Urology,2017,99: 186-191. [4] AL-ANSARI A, YOUNES N, SAMPIGE VP, et al. GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for treatment of benign prostatic hyperplasia: a randomized clinical trial with midterm follow-up[J]. Eur Urol,2010,58(3):349-355. [5] MAVUDURU RM, MANDAL AK, SINGH SK, et al. Comparison of HoLEP and TURP in terms of efficacy in the early postoperative period and perioperative morbidity[J]. Urol Int,2009,82(2):130-135. [6] SANDHU JS, JY L, DAS AK. Photoselective vaporization of the prostate: application, outcomes and safety[J]. Can J Urol,2019,26(4 Suppl 1):8-12. [7] SUN J, SHI A, TONG Z, et al. Green light photoselective vaporization of the prostate: a safe and effective treatment for elderly high-risk benign prostate hyperplasia patients with gland over 80ml[J]. Lasers Med Sci,2018,33(8):1693-1698. [8] 刘正超, 蒋涛, 陈志朋, 等. 绿激光直出式剜除和选择性汽化治疗良性前列腺增生症患者的随机对照研究[J]. 第三军医大学学报,2020,42(5):511-516. [9] VELA-NAVARRETE R, ALFARO V, BADIELLA LL, et al. Age-stratified analysis of IPSS and QOL values in Spanish patients with symptoms potentially related to BPH[J]. Eur Urol,2000,38(2):199-207. [10] OELKE M, BACHMANN A, DESCAZEAUD AA, et al. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction[J]. Eur Urol,2013,64(1):118-140. [11] FOSTER HE, BARRY MJ, DAHM P, et al. Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline[J]. J Urol,2018,200(3):612-619. [12] BERQUET G, CORBEL L, DELLA NEGRA E, et al. Prospective evaluation of ambulatory laser vaporization of the prostate for benign prostatic hyperplasia[J]. Lasers Surg Med,2015,47(5):396-402. [13] ANDERSON BB, PARISER JJ, HELFAND BT. Comparison of patients undergoing PVP versus TURP for LUTS/BPH[J]. Curr Urol Rep,2015,16(8):55. [14] MISRAÏ V, PASQUIE M, BORDIER B, et al. Comparison between open simple prostatectomy and green laser enucleation of the prostate for treating large benign prostatic hyperplasia: a single-centre experience[J]. World J Urol,2018,36(5):793-799. [15] ZHONG J, FENG Z, PENG YP, et al. A systematic review and meta-analysis of efficacy and safety following Holmium laser enucleation of prostate and transurethral resection of prostate for benign prostatic hyperplasia[J]. Urology,2019,131: 14-20. [16] LAI S, PENG P, DIAO T, et al. Comparison of photoselective green light laser vaporisation versus traditional transurethral resection for benign prostate hyperplasia: an updated systematic review and meta-analysis of randomised controlled trials and prospective studies[J]. BMJ Open,2019,9(8):e028855. [17] CINDOLO L, RUGGERA L, DESTEFANIS P, et al. Vaporize, anatomically vaporize or enucleate the prostate? The flexible use of the GreenLight laser[J]. Int Urol Nephrol,2017,49(3):405-411. [18] NGUYEN DD, MISRAÏ V, BACH T, et al. Operative time comparison of aquablation, greenlight PVP, ThuLEP, GreenLEP, and HoLEP[J]. World J Urol,2020,38(12):3227-3233. [19] GASMI A, KHENE ZE, GUÉRIN S, et al. Propensity-score analysis comparing perioperative and functional outcomes between XPS 180 W-photovaporization and GreenLight laser enucleation of the prostate: reasons to discard vaporization and move to enucleation[J]. World J Urol,2021,39(7):2269-2276. [20] HUET R, PEYRONNET B, KHENE ZE, et al. Prospective assessment of the sexual function after greenlight endoscopic enucleation and greenlight 180W XPS photoselective vaporization of the prostate[J]. Urology,2019,131(131):184-189. [21] PEYRONNET B, ROBERT G, COMAT V, et al. Learning curves and perioperative outcomes after endoscopic enucleation of the prostate: a comparison between GreenLight 532-nm and Holmium lasers[J]. World J Urol,2017,35(6):973-983.
