目的:比较经尿道前列腺电切术(TURP)治疗良性前列腺增生(BPH)继发的导管依赖性尿潴留的疗效。
方法:对连续的导管依赖性BPH患者进行回顾性分析。患者进行匹配,并与接受TURP的相似队列进行比较,对倾向评分匹配的患者对使用非劣效性分析。患者于1、3、6、12个月进行国际前列腺症状评分(IPSS)随访,生活质量(QoL)指数,峰值流速(Qmax)和后尿残余尿(PVR)。
结果:将81例接受Rezüm的患者与相同数量的接受TURP的匹配患者进行比较。接受Rezóm的患者手术时间明显缩短(25.5±8.7vs.103.4±12.6分钟;p<0.001),术中出血量较低(2.4%vs.20.7%,p<0.001),住院时间较短(1.2±0.9vs.2.4±1.3d,p<0.001)和更长的导管时间(12.6±6.0vs.2.3±1.2d,p<0.001),不需要输血.两组之间成功的术后排尿能力相当(90.2%vs.92.7%,p=0.78),分别。尽管接受TURP的患者在1个月和3个月后的排尿结果明显更好,两组在6个月和12个月后的平均IPSS(11.1±6.4vs.10.8±3.4,p=0.71),QoL指数(2.4±1.6与2.1±2.3,p=0.33)和Qmax(22.0±7.7v.19.8±6.9ml/sec,p=0.06)。
结论:本研究支持Rezüm在治疗继发于BPH的导管依赖性患者中的安全性和有效性,具有与TURP相当的功能结果。在获得随机临床比较之前,主要推荐长期数据比较复发率和再手术率.
OBJECTIVE: To compare the efficacy of Rezūm with a matched cohort of patients undergoing transurethral resection of the prostate (TURP) for catheter-dependent urine retention secondary to benign prostate hyperplasia (BPH).
METHODS: A retrospective review was performed for consecutive catheter-dependent patients who underwent Rezūm for BPH. Patients were matched and compared with a similar cohort undergoing TURP, using non-inferiority analysis on propensity score-matched patient pairs. Patients were followed up at 1, 3, 6 and 12 months by international prostate symptoms score (IPSS), quality of life (QoL) index, peak flow rate (Qmax) and postvoid residual urine (PVR).
RESULTS: Eighty-one patients undergoing Rezūm were compared with equal number of matched patients who undergoing TURP. Patients undergoing Rezūm experienced significantly shorter operation time (25.5 ± 8.7 vs. 103.4 ± 12.6 min; p < 0.001), lower intraoperative bleeding (2.4% vs. 20.7%, p < 0.001), shorter hospital stay (1.2 ± 0.9 vs. 2.4 ± 1.3 d, p < 0.001) and longer catheter time (12.6 ± 6.0 vs. 2.3 ± 1.2 d, p < 0.001), with no need for transfusion. Successful postoperative voiding was comparable between both arms (90.2% vs. 92.7%, p = 0.78), respectively. Despite patients undergoing TURP had significantly better voiding outcomes after 1 and 3 months, both groups were comparable after six and 12 months in terms of mean IPSS (11.1 ± 6.4 vs. 10.8 ± 3.4, p = 0.71), QoL indices (2.4 ± 1.6 vs. 2.1 ± 2.3, p = 0.33) and Qmax (22.0 ± 7.7 v. 19.8 ± 6.9 ml/sec, p = 0.06).
CONCLUSIONS: This study supports the safety and efficacy of Rezūm in the management of catheter-dependent patients secondary to BPH, with comparable functional outcomes to TURP. Until a randomized clinical comparison is available, long-term data are crucially recommended to compare the recurrence and reoperation rates.