Comparison of therapeutic effects of green laser enucleation of the prostate and transurethral prostate resection for treatment of benign prostatic hyperplasia

Shuang WEN; Lin YANG; Jun LUO; Bo XIONG; Hongzhi WANG; Chengguo ZHANG; Yarong WANG; Changjian ZHENG

doi:10.16016/j.1000-5404.202004032

您当前的位置：

首页 >

文章列表页 >

Comparison of therapeutic effects of green laser enucleation of the prostate and transurethral prostate resection for treatment of benign prostatic hyperplasia

Clinical Medicine | 更新时间：2026-01-09

- Comparison of therapeutic effects of green laser enucleation of the prostate and transurethral prostate resection for treatment of benign prostatic hyperplasia
- Journal of Third Military Medical University Vol. 42, Issue 18, Pages: 1868-1874(2020)
- 作者机构：
  
  402760 重庆，重庆市璧山区人民医院泌尿外科
- 作者简介：
- 基金信息：
- DOI：10.16016/j.1000-5404.202004032
  CLC： R697.32; R699.8
- Received：03 April 2020，
  
  Revised：2020-05-21，
  
  Published：30 September 2020
- 稿件说明：
移动端阅览
Shuang WEN, Lin YANG, Jun LUO, et al. Comparison of therapeutic effects of green laser enucleation of the prostate and transurethral prostate resection for treatment of benign prostatic hyperplasia[J]. Journal of Third Military Medical University, 2020, 42(18): 1868-1874.
DOI：

Shuang WEN, Lin YANG, Jun LUO, et al. Comparison of therapeutic effects of green laser enucleation of the prostate and transurethral prostate resection for treatment of benign prostatic hyperplasia[J]. Journal of Third Military Medical University, 2020, 42(18): 1868-1874. DOI： 10.16016/j.1000-5404.202004032.

摘要

目的

对比分析经尿道前列腺绿激光剜除术(green laser enucleation of prostate，GreenLEP)与经尿道前列腺电切术(transurethral resection of the prostate，TURP)治疗良性前列腺增生症(benign prostatic hyperplasia，BPH)的效果。

方法

回顾性分析本院2017年2月至2018年11月收治的BPH患者104例，分别接受绿激光剜除术(GreenLEP组，52例)和电切术(TURP组，52例)治疗，评测两组患者手术时间、术中出血量、手术切除的前列腺体积以及术后膀胱冲洗时间、术后尿管留置时间、住院时间等相关指标，并比较手术前及手术后1、6个月的前列腺症状评分(IPSS)、生活质量(QoL)、最大尿流率(Qmax)、剩余尿量(PVR)、前列腺特异性抗原(PSA)、前列腺体积(PV)等指标。

结果

两组患者术后的Qmax、QoL、PVR、PSA、PV、IPSS和IIEF指标均较术前明显改善(

0.001)。GreenLEP组的Qmax[(22.03±3.01)

(19.08±2.62)mL/s，

0.001

]

和IPSS评分[(5.35±1.67)

(7.92±2.19)，

0.001

]

优于TURP组，但两组QoL、PVR、PSA、PV等差异无统计学意义。手术安全性比较：GreenLEP组在 PV≤60 mL(较小体积) 时术后膀胱冲洗时间优于 TURP 组[(18.88±2.36)

(34.33 ±2.90)h，

0.001

]

；GreenLEP组在前列腺中等体积(60mL

80mL)时术中出血量[(63.30±4.27)

(77.28±6.19)mL，

0.001

]

、术后膀胱冲洗时间[(23.11±1.91)

(41.56±3.15)h，

0.001

]

、术后住院时间[(3.07±0.61)

(3.88±0.88)d，

0.001

]

均优于TUPR组，而两组手术时间及前列腺切除体积差异无统计学意义；GreenLEP组在PV≥80 mL(较大体积)时，在所有监测指标上均优于TURP组(

0.001)。GreenLEP组术后一过性尿失禁发生率高于TURP组，而GreenLEP术后低钠血症、性功能障碍、电切综合征发生率及术后输血率显著低于TURP组，差异均有统计学意义(

0.05)。

结论

GreenLEP治疗BPH患者与TURP效果相当，在减少术中出血、术后膀胱冲洗时间、术后住院时间及降低术后并发症发生率上有明显优势，可能更加适合前列腺体积较大的患者。

Abstract

Objective

To evaluate the therapeutic effect of green laser enucleation of the prostate (GreenLEP) and transurethral resection of the prostate (TURP) for treatment of benign prostatic hyperplasia (BPH).

Methods

From February

2017 to November

2018

104 patients with BPH were treated with either GreenLEP (52 cases) or TURP (52 cases) in our hospital. The operation time

intraoperative bleeding volume

resected prostate volume

postoperative bladder irrigation time

postoperative catheter indwelling time and hospitalization time as well as the international prostate symptom scores (IPSS)

quality of life (QoL)

maximum flow rate (Qmax)

postvoid residual urine volume (PVR)

prostate specific antigen (PSA)

and prostate volume (PV) before and at 1 month and 6 months after the operation were compared between the 2 groups.

Results

The symptoms and quality of life of the patients improved significantly after the operation in both groups. Compared with those in TURP group

the patients in GreenLEP group had better postoperative Qmax (22.03±3.01

19.08±2.62 mL/s

0.001) and IPSS (5.35±1.67

7.92±2.19

0.001) with similar QoL

PVR

PSA

and PV. In patients with a PV no greater than 60 mL

the postoperative bladder irrigation time was significantly shorter in GreenLEP group than in TURP group (18.88±2.36

34.33±2.90 h

0.001). In patients with a PV of 60-80 mL

compared with the TURP group

the GreenLEP group had significantly less intraoperative blood loss (63.30±4.27

77.28±6.19 mL

0.001) and shorter postoperative bladder irrigation time (23.11±1.91

41.56±3.15 h

0.001) and postoperative hospital stay (3.07±0.61

3.88±0.88 days

0.001) without significant differences in the operation time or prostatectomy volume. In patients with a PV beyond 80 mL

the assessed parameters in GreenLEP group were all superior to those in TURP group (

0.001). The GreenLEP group recorded a significantly higher incidence of postoperative transient urinary incontinence but lower incidences of postoperative hyponatremia

sexual dysfunction

electrocut syndrome and posto

perative blood transfusion than TURP group (

0.05).

Conclusion

For treatment of BPH

GreenLEP has similar therapeutic effect to TURP

but GreenLEP is associated with reduced intraoperative bleeding

shorter postoperative bladder irrigation time and postoperative hospital stay and lowered incidences of postoperative complications especially in patients with a large PV.

关键词

Keywords

references

CINDOLO L, PIROZZI L, FANIZZA C, et al . Drug adhe-rence and clinical outcomes for patients under pharmacological therapy for lower urinary tract symptoms related to benign prostatic hyperplasia: population-based cohort study[J ] . Eur Urol, 2015, 68(3): 418-425. DOI: 10.1016/j.eururo.2014.11.006.

ANDERSON B B, PARISER J J, HELFAND B T. Comparison of patients undergoing PVP versus TURP for LUTS/BPH[J]. Curr Urol Rep, 2015, 16(8): 1-8. DOI: 10.1007/s11934-015-0525-7.

MORDASINI L, DI BONA C, KLEIN J, et al . 80-W GreenLight laser vaporization versus transurethral resection of the prostate for treatment of benign prostatic obstruction: 5-year outcomes of a single-center prospective randomized trial[J ] . Urology, 2018, 116: 144-149. DOI: 10.1016/j.urology.2018.01.037.

MALEK R S, BARRETT D M, KUNTZMAN R S. High-power potassium-titanyl-phosphate (KTP/532) laser vaporization prostatectomy: 24 hours later[J]. Urology, 1998, 51(2): 254-256. DOI: 10.1016/S0090-4295(97)00613-4.

CHO S, KWON S S, LEE K W, et al . A multicenter real-life study of the efficacy of an alpha-blocker with or without anticholinergic agent (imidafenacin) treatment in patients with lower urinary tract symptoms/benign prostatic hyperplasia and storage symptoms[J ] . Int J Clin Pract, 2017, 71(5): e12938. DOI: 10.1111/ijcp.12938.

EL-ASSMY A, ELSHAL A M, MEKKAWY R, et al . Erectile and ejaculatory functions changes following bipolar versus monopolar transurethral resection of the prostate: a prospective randomiz ed study[J ] . Int Urol Nephrol, 2018, 50(9): 1569-1576. DOI: 10.1007/s11255-018-1950-6.

JIANG Y L, QIAN L J. Transurethral resection of the prostate versus prostatic artery embolization in the treatment of benign prostatic hyperplasia: a meta-analysis[J]. BMC Urol, 2019, 19(1): 1-8. DOI: 10.1186/s12894-019-0440-1.

YANG E J, LI H, SUN X B, et al . Bipolar versus monopolar transurethral resection of the prostate for benign prostatic hyperplasia: safe in patients with high surgical risk[J ] . Sci Rep, 2016, 6: 21494. DOI: 10.1038/srep21494.

何幸福, 田彬, 李见波.经尿道双极等离子前列腺电切术治疗前列腺增生症的疗效及对患者尿道功能与机体功能的影响[J].转化医学电子杂志, 2017, 4(8): 58-60. DOI: 10.3969/j.issn.2095-6894.2017.08.018.

HE X F, TIAN B, LI J B. Efficacy of transurethral bipolar plasma kinetic resection of the prostate for treatment of benign prostatic hyperplasia and its effect on patients' urethral function and body function[J]. J Transl Med, 2017, 4(8): 58-60. DOI: 10.3969/j.issn.2095-6894.2017.08.018.

THANGASAMY I A, CHALASANI V, BACHMANN A, et al . Photoselective vaporisation of the prostate using 80-W and 120-W laser versus transurethral resection of the prostate for benign prostatic hyperplasia: a systematic review with meta-analysis from 2002 to 2012[J ] . Eur U rol, 2012, 62(2): 315-323. DOI: 10.1016/j.eururo.2012.04.051.

GONG Y G, LIU R M, GAO R. Photoselective vaporesection of the prostate with a front-firing lithium triborate laser: surgical technique and experience after 215 procedures[J]. Eur Urol, 2015, 67(6): 1152-1159. DOI: 10.1016/j.eururo.2014.12.021.

陈晖, 汤平, 欧汝彪, 等.开放前列腺切除术与经尿道前列腺电切术治疗大体积前列腺增生安全性的Meta分析[J].实用医学杂志, 2012, 28(11): 1800-1802. DOI: 10.3969/j.issn.1006-5725.2012.11.019.

CHEN H, TANG P, OU R B, et al . Meta-analysis of transurethral resection of the prostate versus open prostatectomy for benign prostatic hyperplasia with large volume prostate[J ] . J Pract Med, 2012, 28(11): 1800-1802. DOI: 10.3969/j.issn.1006-5725.2012.11.019.

EREDICS K, WACHABAUER D, RÖTHLIN F, et al . Reoperation rates and mortality after transurethral and open prostatectomy in a long-term nationwide analysis: have we improved over a decade?[J ] . Urology, 2018, 118: 152-157. DOI: 10.1016/j.urology.2018.04.032.

MISRAI V, KEREVER S, PHE V, et al . Direct comparison of GreenLight laser XPS photoselective prostate vaporization and GreenLight laser en bloc enucleation of the prostate in enlarged glands greater than 80 mL: a study of 120 patients[J ] . J Urol, 2016 , 195(4 Pt 1): 1027-1032. DOI: 10.1016/j.juro.2015.10.080.

KUMAR N, VASUDEVA P, KUMAR A, et al . Prospective randomized comparison of monopolar TURP, bipolar TURP and photoselective vaporization of the prostate in patients with benign prostatic obstruction: 36 months outcome[J ] . Luts: Low Urin Tract Symptoms, 2018, 10(1): 17-20. DOI: 10.1111/luts.12135.

RIEKEN M, ANTUNES-LOPES T, GEAVLETE B, et al . What is new with sexual side effects after transurethral male lower urinary tract symptom surgery?[J ] . Eur Urol Focus, 2018, 4(1): 43-45. DOI: 10.1016/j.euf.2018.05.001.

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. DOI: 10.16016 /j.1000-5404.201911198.

LIU Z C, JIANG T, CHEN Z P, et al . Green light top-firing sharpenucleation of prostate versus photoselective vaporisation of prostate for benign prostatic hyperplasia: a randomized controlled trial[J ] . J Third Mil Med Univ, 2020, 42 (5): 511-516. DOI: 10.16016 /j.1000-5404.201911198.

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Photoselective enucleation of prostate versus tranuretheral resection of the prostate for large-size benign prostatic hyperplasia: a randomized prospective controlled study

Green light top-firing sharp enucleation of prostate versus photoselective vaporisation of prostate for benign prostatic hyperplasia: a randomized controlled trial

Management for late complications after transurethral resection of the prostate

Related Author

沈文浩

周占松

周远秀

周晓洲

王永权

陈志朋

蒋涛

郑俊

Related Institution

Department of Urology, First Affiliated Hospital, Army Medical University (Third Military Medical University)

⁰