ABSTRACT
Objective:
To explore the
efficacy and
safety of transurethral anatomical vapor incision
technique of
prostate (VIT) with six-step
method high
power side-emitting greenlight
laser in the
treatment of
benign prostatic hyperplasia (BPH).
Methods:
A retrospective
analysis of 82
patients with BPH
who used high
power side-out green
laser in the
treatment from October 2018 to June 2020 in Gongli
Hospital of Naval Medical
University was performed. Among them, 40
patients were treated with six-step
method VIT, and 42
patients were treated with photoselective
vaporization of
prostate (PVP). The two groups of
patients were compared in age [(71.1±8.7)years vs.(72.1±7.0)years],
prostate volume [75 (68.25, 89.00) ml vs. 73 (63.25, 85.00) ml], and peak urinary flow rate (Q max) [6.20 (5.20, 8.20) ) ml/s vs. 5.9 (4.75, 7.50) ml/s], post-void
residual volume (PVR) [74.00 (42.50, 103.75) ml vs. 67.00 (58.00, 84.50) ml], international
prostate symptom score (IPSS) [(21.2±5.2) vs. ( 21.0±3.9)],
quality of life score (QOL) [5 (4, 6) vs. 5 (4, 6) ],
prostate specific antigen (PSA) [6.20 (4.12, 8.43) ng/ml vs. 5.40 (3.88, 7.13) ng/ml ]. In general, there was no statistical difference ( P>0.05). The VIT group adopts the six-step
method of marking, removing
film, grooving, excision, trimming and crushing. In the PVP group, the
prostate tissue was uniformly vaporized layer by layer from the inside to the outside. Perioperative indexes and
complications were compared between the two groups. The Q max, IPSS, QOL, PVR and PSA between the two groups before and 3 months after
surgery were compared.
Results:
All
patients in the VIT group and PVP group successfully completed the
surgery, and there was no case of transfer to
TURP or open
surgery. The average operation
time was [60.00(50.00, 73.75)min vs. 70.00(50.00, 73.75)min] ( P<0.05). There was no significant difference in the amount of postoperative
hemoglobin decline[15.00(10.00, 17.75)g/L vs. 16.00(14.00, 19.25)g/L], average
bladder irrigation
time[1(1, 1)d vs. 1(1, 1)d], indwelling
catheterization time[3(3, 3)]d vs. 3(3, 3)d] and
hospitalization time in
patients after operation[4(3, 4)d vs. 4(4, 4)d] ( P>0.05). All
patients had no
blood transfusion, second
bleeding, readmission, TURS,
urethral stricture and
urinary incontinence.There were 2 cases (5.0%) of postoperative
urinary tract infection in the VIT group and 9 cases (21.4%) of postoperative
urinary tract infection in the PVP group ( P<0.05), and they were cured after anti-inflammatory
treatment. Three months after operation, Q max, IPSS, QOL, PVR and PSA in the two groups were significantly improved compared with preoperatively. Among them, the differences of IPSS [(5.7±2.5) points vs. (7.5±2.8) points] and PSA [2.65(2.10, 3.90)ng/ml vs. 4.00(2.45, 4.45)ng/ml] in the VIT group and PVP group after operation were statistically significant ( P<0.05).
Conclusions:
Applying the six-step
method high
power side-emitting greenlight
laser transurethral anatomical VIT to treat BPH, there is less intraoperative and postoperative
bleeding, short operation
time, significant decrease in PSA, and fewer
complications. It is a safe and effective minimally invasive
technology for the
treatment of BPH.