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Title: [Comparative observation of thulium laser resection of the prostate-tangerine technique and transurethral resection of the prostate for the treatment of benign prostatic hyperplasia of various sizes].
Author: Tian Y, Luo GH, Yang XS, Xia SJ, Sun ZL.
Journal: Zhonghua Yi Xue Za Zhi; 2019 Feb 12; 99(6):423-427. PubMed ID: 30786335.
Abstract:
Objective: To compare the efficiency and safety of thulium laser resection of the prostate-tangerine technique (TmLRP-TT) and transurethral resection of the prostate (TURP) for the treatment of benign prostatic hyperplasia (BPH) of various sizes. Methods: Clinical data of 249 BPH patients received TmLRP-TT or TURP were retrospectively collected. Patients were divided into small prostate group [prostate volume (PV)<40 ml], medium prostate group (40 ml≤PV<80 ml) and large prostate group (PV ≥ 80 ml) based on transrectal ultrasound (TRUS) results. Age, PV, Prostate-specific antigen (PSA), International prostate symptom score (IPSS), Quality of life (QoL), maximum of flow rate (Q(max)) and post-void residual urine (PVR) of patients received TmLRP-TT or TURP in each group were analyzed, as well as the perioperative data including operation time, hemoglobin and serum sodium level, transfusion, postoperative length of indwelling catheter and postoperative hospital stay. Furthermore, the postoperative complication rates of patients received the two operative methods in each group up to follow-up of 6 months were compared. Results: As for baseline indicators, there were no significant differences regarding age, prostate volume, PSA, IPSS, QoL, Qmax and PVR of patients received TmLRP-TT or TURP in each group (all P>0.05). In the small prostate group, there were no significant differences with operation time, hemoglobin and serum sodium level, transfusion, postoperative length of indwelling catheter and postoperative hospital stay received TmLRP-TT or TURP (all P>0.05). For the medium prostate group, patients received TmLRP-TT underwent longer operation time [(67.4±15.1) vs (57.5±11.5) min, P<0.001], but shorter length of indwelling catheter [(1.5±0.6) vs (3.1±0.9) d, P<0.001] and postoperative hospital stay [(3.5±0.9) vs (5.6±1.0) d, P<0.001], and there were no significant differences regarding transfusion rate (3/73 vs 1/78, P=0.280), hemoglobin [(9.8±9.0) vs (12.2±9.6) g/L, P=0.107] and serum sodium decrease [(2.07±3.65) vs (2.97±3.35) mmol/L, P=0.373]. In the large prostate group, patients received TmLRP-TT also underwent longer operation time [(86.5±14.3) vs (76.7±14.6) min, P=0.022], but less hemoglobin [(11.3±13.8) vs (23.3±15.0) g/L, P=0.006] and serum sodium decrease [(2.41±2.67) vs (4.00±6.22) mmol/L, P=0.042], lower transfusion rate (5/27 vs 0/24, P=0.026), and shorter length of indwelling catheter [(1.8±0.7) vs (4.3±1.5) d, P<0.001] as well as postoperative hospital stay [(3.7±1.1) vs (6.1±1.7) d, P<0.001]. Less overall complications were encountered in the medium (38/73 vs 24/78, P=0.008) and large (26/27 vs 10/24, P<0.001) prostate group who received TmLRP-TT, which was not seen in the small prostate group (P=0.589). Conclusions: TmLRP-TT and TURP are similarly efficient for the treatment of BPH of various sizes. For BPH patients with medium and large prostate, TmLRP-TT demonstrated significant advantages in reducing the overall complications, although the operation time was slightly longer. 目的： 比较铥激光前列腺剥橘式切除术（TmLRP-TT）与经尿道前列腺电切术（TURP）在不同体积良性前列腺增生（BPH）治疗中的有效性和安全性。 方法： 回顾收集贵州省人民医院249例接受TmLRP-TT或TURP的BPH患者临床数据。以经直肠超声测得的前列腺体积（PV）分为小体积BPH组（PV<40ml）、中等体积BPH组（40 ml≤PV<80 ml）以及大体积BPH组（PV≥80 ml）。分别比较各组内接受TmLRP-TT或TURP患者的年龄、前列腺体积、前列腺特异性抗原（PSA）、国际前列腺症状评分（IPSS）、生活质量评分（QoL）、最大尿流率（Q(max)）以及残余尿量（PVR）等基线情况，同时收集手术时间、血红蛋白及血钠下降情况、输血情况、术后尿管留置时间、术后住院时间等围手术期指标以及术后随访6个月内的并发症情况并进行分析。 结果： 各组内患者年龄、PV、PSA、IPSS、QoL、Q(max)以及PVR等基线指标差异无统计学意义（P>0.05）。小体积组患者两种术式手术时间、血红蛋白及血钠下降情况、输血情况、术后尿管留置时间、术后住院时间等指标差异均无统计学意义（均P>0.05）。中等体积组接受TmLRP-TT者手术时间更长[（67.4±15.1）与（57.5±11.5）min，P<0.001]，但术后尿管留置时间[（1.5±0.6）与（3.1±0.9）d，P<0.001]及住院时间更短[（3.5±0.9）与（5.6±1.0）d，P<0.001]，而输血[（3/73与1/78，P=0.280）、血红蛋白[（9.8±9.0）与（12.2±9.6）g/L，P=0.107]及血钠[（2.07±3.65）与（2.97±3.35）mmol/L，P=0.373]下降情况差异均无统计学意义。大体积组接受TmLRP-TT者手术时间更长[（86.5±14.3）与（76.7±14.6）min，P=0.022]，但血红蛋白[（11.3±13.8）与（23.3±15.0）g/L，P=0.006]和血钠[（2.41±2.67）与（4.00±6.22）mmol/L，P=0.042]下降、输血情况[（5/27）与（0/24），P=0.026]、术后尿管留置时间[（1.8±0.7）与（4.3±1.5）d，P<0.001）以及术后住院时间[（3.7±1.1）与（6.1±1.7）d，P<0.00]方面更具优势。随访6个月各组患者接受TmLRP-TT或TURP两种术式相比IPSS、QoL、Q(max)以及PVR差异均无统计学意义（均P>0.05）。中等体积组[（38/73）与（24/78），P=0.008]和大体积组[（26/27）与（10/24），P<0.001]接受TmLRP-TT总体并发症控制优势明显，而小体积组无显著差异（P=0.589）。 结论： 对于不同体积良性前列腺增生患者TmLRP-TT和TURP有效性相似。但对于中等及大体积BPH患者，TmLRP-TT尽管手术时间稍长，但在并发症总体控制方面更具优势，可显著提高围手术期安全性。.

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