Abstract：Objective： To explore the application of photoselective vaporization of the prostate with accurate design of three-dimensional reconstruction in the treatment of high-risk benign prostatic hyperplasia （BPH） and its effect on shortening the learning curve. Methods： A total of 120 patients with high-risk benign prostatic hyperplasia who underwent photoselective vaporization of the prostate in our hospital were included in this study. A total of 60 patients in the experimental group were treated with three-dimensional reconstruction. The control group was treated with a routine clinical pathway. The perioperative, intraoperative data and follow-up results were compared to verify the effect of the accurate design of three-dimensional reconstruction. Results： The operation time in the experimental group and control group was （35.20 ±8.74） and （44.45 ±6.77） min respectively. In the experimental group, the operation time was shorter and the slope of the learning curve was higher （the experimental group： b=5.9, R2=0.309; the control group： b=0.193, R2=0.208）. There was no significant difference in the efficacy and safety between the two groups. Conclusion： The three-dimensional reconstruction technique has a very good preoperative design and guiding significance in the diagnosis and treatment of high-risk patients. It can accurately predict the green laser energy needed during the operation and provide a feasible quantitative index for the operation. In addition, it can directly show the prostate volume, the structure of the prostatic urethra and the shape of the prostate protruding into the bladder to the patients and the operator, which is beneficial to the accurate operation. It can minimize trauma on the premise of ensuring the curative effect so that patients with high risk of surgery can also receive surgical treatment more safely.
左世栋, 董金凯, 曲楠, 王璐, 孔令生, 李学超, 付成伟, 张勇杰, 陈立军. 三维重建对高风险良性前列腺增生患者精准治疗的作用[J]. 微创泌尿外科杂志, 2022, 11(1): 38-42.
Zuo Shidong, Dong Jinkai, Qu Nan, Wang Lu, Kong Lingsheng, Li Xuechao, Fu Chengwei, Zhang Yongjie, Chen Lijun. A preliminary study on the effect of three-dimensional reconstruction on accurate treatment of patients with high risk benign prostatic hyperplasia. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2022, 11(1): 38-42.
[1] Chughtai B, Forde JC, Thomas DD, et al. Benign prostatic hyperplasia[J]. Nat Rev Dis Primers,2016,2:16031. [2] Lerner LB, Mcvary KT, Barry MJ, et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA GUIDELINE PART II-Surgical evaluation and treatment[J]. J Urol,2021,206(4):818-826. [3] Cornu JN, Ahyai S, Bachmann A, et al. A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update[J]. Eur Urol,2015,67(6):1066-1096. [4] 晁宝婷,吕家驹,孙亮,等.基于肾血管CT三维重建检查结果的改良右肾动脉离断法在腹腔镜右肾癌并静脉癌栓切除术中的应用[J].中华泌尿外科杂志,2021,42(10):730-734. [5] Risacher SL, Mcdonald BC, Tallman EF, et al. Association between anticholinergic medication use and cognition, brain metabolism, and brain atrophy in cognitively normal older adults[J]. JAMA Neurol,2016,73(6):721-732. [6] Gray SL, Anderson ML, Dublin S, et al. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Intern Med,2015,175(3):401-407. [7] Nickel JC. Surgical therapy for benign prostatic hyperplasia: Almost three decades of change. Can Urol Assoc J,2020,14(8):258. [8] Mariappan P, Brown DJ, Mcneill AS. Intravesical prostatic protrusion is better than prostate volume in predicting the outcome of trial without catheter in white men presenting with acute urinary retention: a prospective clinical study. J Urol,2007,178(2):573-577; discussion 577. [9] Matsukawa Y, Ishida S, Majima T, et al. Intravesical prostatic protrusion can predict therapeutic response to silodosin in male patients with lower urinary tract symptoms. Int J Urol,2017,24(6):454-459. [10] Zhou Y, Xue B, Mohammad NA, et al. Greenlight high-performance system (HPS) 120-W laser vaporization versus transurethral resection of the prostate for the treatment of benign prostatic hyperplasia: a meta-analysis of the published results of randomized controlled trials. Lasers Med Sci,2016,31(3):485-495. [11] Gómez-Sancha F. The constant search for the greater good: evolving from TURP to anatomic enucleation of the prostate is a safe bet. World J Urol,2021,39(7):2401-2406. [12] Azizi M, Tholomier C, Meskawi M, et al. Safety, perioperative, and early functional outcomes of vapor incision technique using the GreenLight XPS 180 W system: direct comparison with photoselective vaporization of the prostate. J Endourol,2017,31(1):43-49. [13] Gratzke C, Bachmann A, Descazeaud A, et al. EAU guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol,2015,67(6):1099-1109. [14] Rasing M, Van Son M, Moerland M, et al. Value of targeted biopsies and combined PSMA PET/CT and mp-MRI imaging in locally recurrent prostate cancer after primary radiotherapy. Cancers (Basel),2022,14(3):781.
