Prostate:钬激光前列腺剜除术的复发预测因子调查

2021-11-28 AlexYang MedSci原创

评估了接受HoLEP患者的长期结果、症状复发率和预测因素。

良性前列腺增生(BPH)是导致男性下尿路症状(LUTS)最常见的原因之一。手术治疗通常是中度/重度药物难治性LUTS患者的首选治疗方法。几十年来,经尿道前列腺切除术(TURP)和开放式前列腺切除术(OP) 是治疗小型/中型和大型前列腺的金标准

前列腺钬激光剜除术(HoLEP)是目前研究最多的良性前列腺增生(BPH)手术技术之一,其在缓解症状方面的疗效已有广泛描述。然而,关于症状复发预测因子的相关证据很少。近期,来自意大利的研究人员在《Prostate》上发表文章,评估了接受HoLEP患者的长期结果、症状复发率和预测因素

研究人员分析了2012年至2015年,在两个三级转诊中心连续接受HoLEP治疗的前列腺增生患者的数据。在12个月、24个月和60个月的随访中,通过尿流率参数和国际前列腺症状评分(IPSS)问卷评估了功能结果。主要结果是有症状的患者在手术后60个月出现下尿路症状(LUTS)的比例,下尿路症状定义为出现以下一项或多项情况:IPSS超过7,排尿后残留物(PVR)超过20毫升,需要对LUTS进行药物治疗或因膀胱出口梗阻重新进行手术。多变量逻辑回归分析评估了随访时出现症状的预测因素。协变量包括:术前峰值流量(PFR)、PVR和IPSS、前列腺体积、年龄(均为连续)和手术技术。

共有567名患者的数据可用于分析。术前所有患者的前列腺体积中位数为80cc,PFR中位数为8ml/s,PVR中位数为100cc。所有患者在手术后1年时的症状缓解非常理想,IPSS评分中位数为4(2-5),PFR为26.5(23-32)ml/s。队列的中位数(IQR)随访时间为76(62-81)个月。60个月时,PFR和PVR的中位数分别为23(18-26)ml/s和10ml(5-15)。随访时发现125名(22%)患者有症状,有25名(4.4%)患者需要重做手术。在调整了可能的混杂因素后,术前PVR(几率[OR]1.005)和IPSS(OR 1.12)的增加为症状复发的独立预测因素(所有P<0.001)。

HolEP手术60个月后,有症状患者预测因子的多变量逻辑回归分析

综上所述,无论选择何种技术,HoLEP都能持久地缓解症状对于术前有重要症状或高PVR的患者,应仔细考虑症状复发的风险

原始出处:

Matteo Droghetti Angelo Porreca, Lorenzo Bianchi et al. Long-term outcomes of Holmium laser enucleation of prostate and predictive model for symptom recurrence. Prostate. Oct 2021

 

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    2021-11-30 oliver169
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    2021-11-30 lsndxfj
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    2021-11-30 sunylz

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