Evaluation of greenlight photoselective vaporization of the prostate for the treatment of high-risk patients with benign prostatic hyperplasia

Aim： To explore the feasibility and safety of greenlight photoselective vaporization of the prostate （PVP） on high-risk patients presenting with lower urinary tract symptoms suggestive of benign prostatic hyperplasia （BPH） and to evaluate their clinical and voiding outcome. Methods： A total of 85 high-risk patients with obstructive BPH underwent PVP with an 80 W potassium-titanyl-phosphate laser, which was delivered through a side-deflecting fiber with a 23 Fr continuous flow cystoscope. Operative time, blood loss, indwelling catheterzation, international prostate symptom score （IPSS）, quality of life score （QoL）, uroflowmetry, postvoid residual urine volume and short-term complication rates were evaluated for all patients. Results： All patients got through the perioperative period safely. The chief advantages of PVP were： short operative time （25.6 ± 7.6 min）, little bleeding loss （56.8 ± 14.3 mL） and short indwelling catheterization （1.6 ± 0.8 d）. The IPSS and QoL decreased from （29.6 ± 5.4） and （5.4 ± 0.6） to （9.5 ± 2.6） and （1.3 ± 0.6）, respectively. The vast majority of patients were satisfied with voiding outcome. The mean maximal urinary flow rate increased to 17.8 mL/s and postvoid residual urine volume decreased to 55.6 mL. These results are significantly different from preoperative data （P 〈 0.05）. No patient required blood transfusion or fluid absorption. There were few complications and very high patient satisfaction after operation. Conclusion： PVP has a short operative time and high tolerance, and is safe, effective and minimally invasive for high-risk patients, therefore it might be considered as a good alternative treatment for high-risk patients with obstructive urinary symptoms as a result of BPH.

Evaluation of greenlight photoselective vaporization of the prostate for the treatment of high-risk patients with benign prostatic hyperplasia

Aim:To explore the feasibility and safely of greenlight photoselective vaporization of the prostate(PVP)on high-risk patients presenting with lower urinary tract symptoms suggestive of benign prostatic hyperplasia(BPH)and to evalu- ate their clinical and voiding outcome.Methods:A total of 85 high-risk patients with obstructive BPH underwent PVP with an 80W potassium-titanyl-phosphate laser,which was delivered through a side-deflecting fiber with a 23 Fr continuous flow cystoscope.Operative time,blood loss,indwelling catheterzation,international prostate symptom score(IPSS),quality of life score(QoL),uroflowmetry,postvoid residual urine volume and short-term complication rates were evaluated for all patients.Results:All patients got through the perioperative period safely.The chief advantages of PVP were:short operative time(25.6±7.6min),little bleeding loss(56.8±14.3mL)and short indwelling catheterization(1.6±0.8d).The IPSS and QoL decreased from(29.6±5.4)and(5.4±0.6)to(9.5±2.6)and(1.3± 0.6),respectively.The vast majority of patients were satisfied with voiding outcome.The mean maximal urinary flow rate increased to 17.8 roLls and postvoid residual urine volume decreased to 55.6mL.These results are signifi- cantly different from preoperative data(P<0.05).No patient required blood transfusion or fluid absorption.There were few complications and very high patient satisfaction after operation.Conclusion:PVP has a short operative time and high tolerance,and is safe,effective and minimally invasive for high-risk patients,therefore it might be considered as a good alternative treatment for high-risk patients with obstructive urinary symptoms as a result of BPH.

In Vitro Study on the Vaporization Ratio of 2-μm Laser in Human Prostatic Tissue

In this study, the vaporization ratio of the 2-μm laser in the prostatic tissue with benign prostatic hyperplasia was examined in vitro, to explore a technique to estimate the clearance rate of prostatic tissue during the transurethral vaporesection of the prostate. A total of 9 fresh prostatic tissue specimens were obtained by open surgery and the wet weight of the prostatic tissue were measured immediately after the sample collection. Under the simulated conditions of transurethral vaporesection of the prostate by 2-μm laser, each prostate gland was completely vaporesected into fragments with a diameter of less than 1.0 cm in vitro tissue were collected and measured. Then After the vaporesection, the whole fragments of prostatic the lost weight of prostatic tissue, the weight of the collected prostatic tissue and the ratio of the lost weight of prostatic tissue to the wet weight of the prostate glandular organ specimen were calculated. The correlation between the weight of collected prostatic tissue and the weight of the whole glandular organ was analyzed. All the experimental procedures were carried out by one operator. Wet weight of the prostatic gland specimen and the weight of the harvested prostatic tissues after the procedure were recorded. With respect to the wet weight of prostate gland specimen, the percentage of the weight of collected prostatic tissue was （34.45±1.51） %, and the percentage of the lost weight of prostatic tissue was （65.55±1.51）%. Satisfactory linear relationship was observed between the weight of collected prostatic tissue and the wet weight of prostate gland specimen [y=3.245x=6.475 （t=15.097, P=0.000）]. It is concluded that under the simulated conditions of transurethral vaporesection of the prostate by 2-μm laser, the vaporization ratio of prostatic tissue can be calculated on the basis of the weight of collected prostatic tissue, and thereby the clearance of prostatic tissue during the formal operation by 2-μm laser could be quantitatively determined.

Two-micron （thulium） laser resection of the prostate- tangerine technique： a new method for BPH treatment

Two-micron （thulium） laser resection of the prostate-tangerine technique （TmLRP-TT） is a transurethral procedure that uses a thulium laser fiber to dissect whole prostatic lobes off the surgical capsule, similar to peeling a tangerine. We recently reported the primary results. Here we introduce this procedure in detail. A 70-W, 2-um （thulium） laser was used in continuous-wave mode. We joined the incision by making a transverse cut from the level of the verumontanum to the bladder neck, making the resection sufficiently deep to reach the surgical capsule, and resected the prostate into small pieces, just like peeling a tangerine. As we resected the prostate, the pieces were vaporized, sufficiently small to be evacuated through the reseetoscope sheath, and the use of the mechanical tissue morcellator was not required. The excellent hemostasis of the thulium laser ensured the safety of TmLRP-TT. No patient required blood transfusion. Saline irrigation was used intraoperatively, and no case of transurethral resection syndrome was observed. The bladder outlet obstruction had clearly resolved after catheter removal in all cases. We designed the tangerine technique and proved it to be the most suitable procedure for the use of thulium laser in the treatment of benign prostatic hyperplasia （BPH）. This procedure, which takes less operative time than standard techniques, is safe and combines efficient cutting and rapid organic vaporization, thereby showing the great superiority of the thulium fiber laser in the treatment of BPH. It has been proven to be as safe and efficient as transurethral resection of the prostate （TURP） during the 1-year follow-up.

Feasibility of en bloc thulium laser enucleation of the prostate in a large case series. Are results enhanced by experience?

Objective:To provide the first large single-operator case series of patients who undergo“en bloc”thulium laser enucleation of the prostate(ThuLEP)and to demonstrate an improvement in enucleation efficacy with experience.Methods:We prospectively evaluated a cohort of patients with symptomatic benign prostatic hyperplasia(BPH)who underwent“en bloc”ThuLEP between May 2015 and November 2017.Association between dependent variables(delivered energy and operating time)and independent variables(adenoma volume and experience)were estimated with regression analysis.The experience was calculated as the time interval between the date of the first operation of the series and the date of the operation being considered.Results:A total of 100 patients were registered for the study.Median operative time was 56.5 min(interquartile range[IQR]:40-85 min).Median enucleation time was 17.4 min(IQR:15-21.5 min).Median enucleation index(enucleation time per adenoma gram)was 0.3 min/g(0.2-0.3 min/g).The overall operative time is not influenced by experience,but we registered a significant trend towards a reduction in the total amount of energy delivered energy normalized per adenoma gram(p=0.0148).Conclusion:We believe that further attention is needed for these new“en bloc”prostatic enucleation techniques,which can facilitate some surgical steps,leading to a widespread use of laser technology for BPH surgical treatment.

Development of a high-power blue diode laser for precision vaporization of prostate tissue for the surgical management of benign prostatic hyperplasia

This paper explores the advancement and application of high-power blue diode lasers in treating benign prostatic hyperplasia(BPH).Addressing the challenges posed by existing techniques,the study focuses on optimizing tissue removal methods.Energy platform for BPH should balance a range of factors,such as operative time,patient conditions,urinary functions,complications,durability,accessibility,and cost,all while prioritizing patient care.Blueray Medical's innovation of high-power blue diode laser systems for BPH surgery is explored,with emphasis on achieving a balance among these considerations.By illustrating the biomedical effects of lasers and their interaction with soft tissues,particularly emphasizing the role of photon absorption by biomolecules and proteins in tissue behavior,this study outlines the advantages of the highpower blue diode laser system.The initial laboratory experiments and clinical results consistently align with our theoretical predictions,especially in terms of tissue vaporization efficiency,tissue coagulation,and bleeding control.In conclusion,blue diode lasers hold potential to enhance surgical outcomes for BPH.Their unique properties offer benefits like improved tissue removal rate and reduced thermal damages.Integrating blue laser technology into BPH protocols could lead to shorter hospital stays,cost savings,and expanded patient eligibility,although rigorous clinical studies are needed to fully understand their benefits and limitations.

Two-micrometer thulium laser resection of the prostate-tangerine technique in benign prostatic hyperplasia patients with previously negative transrectal prostate biopsy

The 2-1μm thulium laser resection of the prostate-tangerine technique （TmLRP-TT） has been introduced as a minimally invasive treatment for benign prostatic hyperplasia （BPH）. This study was undertaken to assess the clinical efficacy and safety of TmLRP-TT for the treatment of BPH patients with previously negative transrectal prostate biopsy. A prospective analysis of 51 patients with previously negative transrectal prostate biopsy who underwent surgical treatment using TmLRP-TT was performed from December 2011 to December 2013. Preoperative status, surgical details, and perioperative complications were recorded. The follow-up outcome was evaluated with subjective and objective tests at I and 6 months. TmLRP-TT was successfully completed in all patients. Mean prostate volume, operative duration, and catheterization time were 93.3 ± 37.9 ml, 69.5 ± 39.5 min, and 6.5 ± 1.3 days, respectively. The mean International Prostate Symptom Score, quality of life score, maximum urinary flow rate, and post-void residual urine volume changed notably at 6-month follow-up （22.5 ± 6.9 vs 6.1 ± 3.2, 4.8 ± 1.3 vs 1.1 ± 0.9, 7.3 ± 4.5 vs 18.9 ± 7.1 ml s^-1, and 148.7 ± 168.7 vs 28.4 ± 17.9 ml）. Two （3.9%） patients required blood transfusion perioperatively, while 3 （5.9%） patients experienced transient hematuria postoperatively, and 2 （3.9%） patients received 3 days recatheterization due to clot retention. TmLRP-TT is a safe and effective minimally invasive technique for patients with previously negative transrectal prostate biopsy during the 6-month follow-up. This promising technology may be a feasible surgical method for previously negative transrectal prostate biopsy in the future.

Efficacy and Safety of 120-W Thulium：Yttrium-Aluminum-Garnet Vapoenucleation of Prostates Compared with Holmium Laser Enucleation of Prostates for Benign Prostatic Hyperplasia

Background： This study compared the efficacy and safety between 120-W thulium：yttrium-aluminum-garnet （Tm：YAG） vapoenucleation of prostates （ThuVEP） and holmium laser enucleation of prostates （HoLEP） for patients with lower urinary tract symptoms （LUTS） due to benign prostatic hyperplasia （BPH）. Methods： A retrospective analysis of 88 consecutive patients with symptomatic BPH was carried out, who underwent either 120-W ThuVEP or HoLEP nonrandomly. Patient demographics and peri-operative and 12-month follow-up data were analyzed with the International Prostate Symptom Score （IPSS）, quality of life （QoL） score, maximum flow rate （Qmax）, postvoid residual urine volume （PVR）＋ and rates of peri-operative and late complications. Results： The patients in each group showed no significant difference in preoperative parameters. Compared with the HoLEP group, patients in the 120-W ThuVEP group required significantly shorter time for laser enucleation （58.3 ± 12.8 min vs. 70.5 ± 22.3 min, P = 0.003）, and resulted in a significant superiority in laser efficiency （resected prostate weight/laser enucleation time） for 120-W Tm：YAG laser compared to holmium：YAG laser （0.69 ± 0.18 vs. 0.61 ± 0.19, P = 0.048）. During 1, 6, and 12 months of follow-ups, the procedures did not demonstrate a significant difference in IPSS, QoL score, Qmax, or PVR （P 〉 0.05）. Mean peri-operative decrease of hemoglobin in the HoLEP group was similar to the ThuVEP group （ 17.1 ± 12.0 g/L vs. 15.2± 10.1 g/L, P = 0.415）. Early and late incidences of complications were low and did not differ significantly between the two groups of 120-W ThuVEP and HoLEP patients （P 〉 0.05）. Conclusions： 120-W ThuVEP and HoLEP are potent, safe and efficient modalities of minimally invasive surgeries for patients with LUTS due to BPH. Compared with HoLEP, 120-W TbuVEP offers advantages of reduction of laser enucleation time and improvement of laser efficiency.

Photoselective vaporization of the prostate in the treatment of benign prostatic hyperplasia

Background The treatment of symptomatic benign prostatic hyperplasia （BPH） remains a challenge for most urologic surgeons. We studied a cumulative cohort of patients with symptomatic benign prostatic hyperplasia （BPH） who underwent photoselective vaporization of the prostate （PVP） and evaluated the efficacy and safety of this procedure. Methods A total of 196 patients with lower urinary tract obstruction symptoms secondary to BPH were treated using laser vaporization of the prostate under sacral canal anesthesia at our institutions. The therapeutic results were assessed using following variables ： the safety and efficacy of sacral anesthesia, blood loss, operative time, indwelling catheterization. Preoperative and perioperative parameters were evaluated in the international prostate symptom score （ IPSS）, quality of life score （ QoL）, maximal urinary flow rate （ Qmax）, post-void residual urine volume （PVR） and the change of sexual function. Patients were also assessed for 3-month follow up. Results PVP was performed successfully for all patients. There were 195 patients under sacral anesthesia and 1 patient under epidural anesthesia. Mean operative time was （45.2±18.5 ） minutes. The mean IPSS decreased from （26.6±3.2 ） to （5.6±1.4） and the QoL score decreased from （5.7±0.4） to （ 1.6±0. 5 ）, respectively （ P 〈 0. 05 ）, while mean Qmax increased from （6.7±2.5 ） ml/s preoperatively to （ 19.6± 2.4 ） ml/s, PVR decreased from 158.4 to 25.8 ml, respectively （ P 〈 0.05）. Average catheterization time was （ 1.8±0. 9） days. There was no significant blood loss or fluid absorption during the period of PVP. Complications consisted of transient dysuria in 3 patients （1.5%）, delayed gross hematuria in 5 patients （2. 5% ）, respectively. Significant improvement in clinical outcomes were noted as early as 3 months after PVP treatment. Conclusions PVP is considered as a high satisfaction rate by complication. Hence, PVP is a novel, safe, effective and minimal symptomatic BPH. patient and a minimal postoperative invasive treatment for patients with symptomatic BPH.

直出式绿激光剜除结合汽化术治疗大体积良性前列腺增生的疗效及体会

目的探讨直出式绿激光剜除结合汽化术(FFGreenLEVP)治疗大体积良性前列腺增生的安全性及有效性。方法回顾性分析2019年1月至2022年12月南京医科大学第二附属医院收治的52例大体积良性前列腺增生患者的临床资料(试验组),前列腺体积80~120 mL,平均(88.92±8.37)mL,均采取FFGreenLEVP治疗。记录并分析手术时间、术中损失血红蛋白量、术中及术后并发症、术后住院时间、术后膀胱冲洗时间、术前及术后2个月国际前列腺症状评分(IPSS)、生活质量指数(QoL)及最大尿流率(Qmax)。将上述指标与2015年5月至2017年10月收治的31例采用经尿道前列腺切除术(TURP)治疗的大体积良性前列腺增生患者的临床资料(对照组)进行比较。结果所有接受FFGreenLEVP治疗的患者均顺利完成手术。手术时间(83.10±10.67)min。术中损失血红蛋白量(10.41±1.20)g。术后膀胱冲洗时间(1.55±0.63)d。术后有6例出现暂时性尿失禁,其中4例拔管后3 d内基本恢复尿控,2例拔管后1周恢复尿控。术后2个月IPSS及QoL评分均显著低于术前,Qmax显著高于术前,差异具有统计学意义(P<0.01)。术后1个月,1例出现轻度尿道外口狭窄,采用尿道扩张后治愈。有46例随访至今无明显复发。与对照组比较,试验组手术时间、术后冲洗时间更短(P<0.01);两组术后2个月QoL评分、IPSS、Qmax比较,差异无统计学意义(P>0.05)。结论FFGreenLEVP治疗大体积良性前列腺增生患者安全有效,可以同时发挥绿激光切割和汽化的优势。

区级医院开展经尿道450 nm蓝激光前列腺汽化术的初步报道

目的初步探讨在区级医院开展经尿道450 nm蓝激光前列腺汽化术治疗良性前列腺增生(BPH)的临床效果,为区级医院BPH治疗方法的选择提供参考。方法回顾性分析2023年1月—9月在西安市长安区医院泌尿外科接受手术治疗的39例BPH患者的临床资料。根据手术方式分为两组,其中蓝激光组(n=19)行经尿道450 nm蓝激光前列腺汽化术,电切组(n=20)行经尿道前列腺电切术(TURP)。比较两组患者的手术时间、血红蛋白下降值、术后膀胱冲洗时间、术后留置尿管时间及并发症发生情况。结果所有患者的手术均顺利完成。两组的手术时间[(45.11±22.08)min vs.(81.25±29.37)min]、术后膀胱冲洗时间[(34.05±9.41)h vs.(47.60±9.05)h]及血红蛋白下降值[(7.79±5.86)g/L vs.(16.40±10.23)g/L]比较,蓝激光组明显低于电切组(P<0.05)。蓝激光组术后尿潴留1例,两组术后留置尿管时间差异无统计学意义(P>0.05)。结论采用450 nm蓝激光前列腺汽化术治疗BPH具有出血量少、手术时间短及术后膀胱冲洗时间少的特点,值得在基层医院推广应用。

450 nm半导体蓝激光“打沟去垄法”治疗大体积良性前列腺增生的疗效 观察

目的分析450 nm半导体蓝激光“打沟去垄法”治疗大体积良性前列腺增生(BPH)的疗效及安全性,以期在临床推广应用。方法回顾性分析2023年9—12月泰安市中心医院迎胜院区泌尿肾病激光治疗中心行450 nm半导体蓝激光“打沟去垄法”治疗30例大体积BPH患者的临床资料,记录患者术中激光出光做功时间、术前及术后血红蛋白(Hb)水平、术后膀胱冲洗时间、尿管留置时间、术后住院时间、术中及术后并发症发生情况。对比患者术前及术后1个月国际前列腺症状评分(IPSS)、生活质量评定量表(QoL)评分、最大尿流率(Qmax)、膀胱残余尿量(PVR)变化情况。结果患者术前前列腺体积为(104.5±14.52)mL,术中激光出光做功时间(20.13±2.98)min,术后膀胱冲洗时间(20.27±2.56)h。所有患者术后2 d拔除导尿管,术后3 d顺利出院。术后1个月IPSS、QoL评分、Qmax、PVR均较术前明显改善,差异有统计学意义(P<0.05)。在随访期间未观察到任何并发症发生。结论采用450 nm半导体蓝激光“打沟去垄法”治疗大体积BPH是一种新型、安全、有效的手术方式。

蓝激光前列腺汽化切除术对良性前列腺增生患者术后性功能及下尿路症状的影响

目的分析蓝激光前列腺汽化切除术治疗良性前列腺增生(BPH)的临床效果及对患者术后性功能及下尿路症状(LUTS)的影响。方法回顾性分析2023年3—8月在泰安市中心医院迎胜院区泌尿肾病激光治疗中心接受手术治疗的91例BPH患者的临床资料,根据不同手术方式分为两组,蓝激光组(n=46)采用经尿道蓝激光前列腺汽化切除术,PKRP组(n=45)采用经尿道前列腺等离子电切术(PKRP)。比较两组患者的手术时间、膀胱冲洗时间、留置尿管时间、住院时间,术前、术后6个月的残余尿量(PVR)、最大尿流率(Qmax)、国际前列腺症状评分(IPSS)、生活质量评分(QoL)、国际勃起功能指数-5(IIEF-5)问卷、射精功能评分量表(CIPE)评分以及逆行射精发生率。结果两组手术时间[(24.66±5.38)min vs.(62.50±3.85)min]、膀胱冲洗时间[(20.40±2.78)h vs.(51.93±5.02)h]、留置尿管时间[(1.65±0.89)d vs.(6.73±2.98)d]及住院时间[(4.26±1.57)d vs.(8.45±2.28)d]比较,蓝激光组均明显短于PKRP组(P<0.05)。两组患者术前及术后6个月Qmax、PVR、QoL及IPSS比较差异无统计学意义(P>0.05)。术后6个月蓝激光组较PKRP组的IIEF-5问卷[(20.02±2.63)分vs.(17.64±1.75)分]及CIPE评分更高[(30.88±3.45)分vs.(26.25±3.51)分],差异具有统计学意义(P<0.05)。蓝激光组术后6个月的逆行射精发生率低于PKRP组(4.35%vs.35.60%,P<0.05)。结论蓝激光前列腺汽化切除术能够改善BPH患者LUTS,并且更好的保护了患者的性功能。

绿激光解剖性汽化术治疗良性前列腺增生伴2型糖尿病疗效观察

目的探讨绿激光解剖性汽化术治疗良性前列腺增生(BPH)伴2型糖尿病(T2DM)患者的效果及其对炎症因子、生活质量和尿道狭窄的影响。方法选择2021年3月至2022年8月于新乡医学院第一附属医院就诊的120例BPH伴T2DM患者为研究对象,根据手术方式将患者分为对照组和观察组,每组60例。对照组患者采用绿激光选择性光汽化术治疗;观察组患者采用绿激光解剖性汽化术治疗。比较2组患者的手术时间、术中出血量、前列腺切除质量、尿管留置时间、膀胱冲洗时间及住院时间等术中及术后恢复指标;分别于术前、术后3 d、术后7 d,采用酶联免疫法检测血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平,免疫荧光法检测血清丙二醛(MDA)、脂质过氧化物(LPO)水平;分别于术前、术后3个月、术后6个月,采用国际前列腺症状量表(IPSS)评估前列腺症状,泌尿症状困扰评分(USDS)评估泌尿症状,动态尿流动力学监测仪测定尿流动力学[最大尿流量(Qmax)、残余尿量(RUV)],酶联免疫法检测血清总前列腺特异性抗原(tPSA)水平,国际勃起功能问卷-5(IIEF-5)评估勃起功能,BPH患者生活质量量表(BPH-QOL)评估生活质量;比较2组患者尿道狭窄、尿路刺激征、膀胱颈挛缩、尿潴留、继发出血等并发症发生率。结果观察组患者的手术时间显著长于对照组,术中出血量显著少于对照组,膀胱冲洗时间、尿管留置时间、住院时间显著短于对照组(P<0.05);2组患者的前列腺切除质量比较差异无统计学意义(P>0.05)。术前,2组患者的血清TNF-α、IL-6、MDA、LPO水平比较差异无统计学意义(P>0.05);术后3、7 d,2组患者的血清TNF-α、IL-6、MDA、LPO水平显著高于术前,且观察组患者的血清TNF-α、IL-6、MDA、LPO水平显著低于对照组(P<0.05)。术前,2组患者的IPSS、USDS评分比较差异无统计学意义(P>0.05)。术后3、6个月,2组患者的IPSS、USDS评分显著低于术前,且观察组患者的IPSS、USDS评分显著低于对照组(P<0.05)。术前,2组患者的RUV、Qmax、血清tPSA水平比较差异无统计学意义(P>0.05)。术后3、6个月,2组患者的RUV、血清tPSA水平显著低于术前,Qmax显著高于术前(P<0.05);观察组患者的RUV、血清tPSA水平显著低于对照组,Qmax显著高于对照组(P<0.05)。术前,2组患者的IIEF-5、BPH-QOL评分比较差异无统计学意义(P>0.05)。术后3、6个月,2组患者的IIEF-5评分显著低于术前,BPH-QOL评分显著高于术前(P<0.05);观察组患者的IIEF-5、BPH-QOL评分显著高于对照组(P<0.05)。对照组和观察组患者的并发症总发生率分别为16.67%(10/60)、5.00%(3/60),观察组患者的并发症总发生率显著低于对照组(χ^(2)=4.227,P<0.05)。结论绿激光解剖性汽化术治疗BPH伴T2DM患者,能优化手术流程,减轻炎症应激,降低并发症风险,促进术后早期恢复,改善尿流动力学及性功能,缓解症状,提高患者生活质量。

经尿道前列腺蓝激光汽化切除术与经尿道前列腺电切术治疗良性前列腺增生的临床疗效比较

目的对比经尿道前列腺蓝激光汽化切除术与经尿道前列腺电切术(TURP)治疗良性前列腺增生(BPH)的临床疗效及安全性。方法回顾性分析2023年1—8月在泰安市中心医院迎胜院区泌尿肾病激光治疗中心接受手术治疗的142例BPH患者的临床资料。根据不同手术方式将患者分为蓝激光组(n=72)行经尿道前列腺蓝激光汽化切除术、电切组(n=70)行TURP。比较两组患者手术时间、血红蛋白(Hb)下降量、膀胱冲洗时间、尿管留置时间、术后住院时间。比较两组患者术前及术后6个月国际前列腺症状评分(IPSS)、生活质量评分(QoL)、最大尿流率(Qmax)、膀胱残余尿量(PVR)、国际勃起功能专项评分(IIEF-5)及并发症发生率。结果两组患者术后6个月的IPSS、QoL、Qmax、PVR均较术前有显著改善(P<0.05),但组间差异无统计学意义(P>0.05)。蓝激光组和电切组患者手术时间[(25.46±5.84)min vs.(47.04±4.03)min]、膀胱冲洗时间[(21.18±4.11)h vs.(54.17±4.99)h]、尿管留置时间[2(2,2)d vs.5(5,6)d]、术后住院时间[4(3,4)d vs.7(7,8)d]、Hb下降量[(4.31±2.34)g/L vs.(9.61±2.16)g/L]及并发症总发生率(4.2%vs.51.4%)比较,蓝激光组明显低于电切组,而蓝激光组术后6个月IIEF-5高于电切组[(20.06±2.13)分vs.(18.93±1.85)分],差异均有统计学意义(P<0.05)。结论经尿道前列腺蓝激光汽化切除术与TURP均可有效治疗BPH,但前者疗效更确切,康复时间更短,并发症更少,对患者性功能影响更小,是一种安全、有效的微创手术方式。

1470 nm半导体激光对离体动物组织的汽化消融、切割和凝固作用

目的观察1470 nm波长的半导体激光对离体动物组织的汽化切割、凝固和热损伤情况,以探讨其应用于前列腺增生治疗的可行性。方法实验组和同类对照组分别使用HANS-D1型和ML-DD01FI型1470 nm半导体激光治疗仪。取新鲜离体猪膀胱组织,光纤距离组织0.5 cm和1 cm的条件下工作5 s,观察60、90、120、150、160 W功率的半导体激光对组织的损伤影响;取离体犬前列腺和猪肾组织分别进行汽化消融和汽化切割,观察60、90、120、150、160 W功率的半导体激光对组织的汽化和热损伤作用;另在凝结模式下照射离体猪肾组织5、10、15 s后,观察30、40、50 W功率的半导体激光对组织的凝固作用。结果光纤照射距离组织1 cm时,1470 nm半导体激光对邻近正常膀胱组织不会产生意外损伤;但在距离0.5 cm时,120、150、160 W的1470 nm半导体激光对膀胱组织有轻微的损伤。另外,随着输出功率的增大,60~160 W半导体激光对犬前列腺组织的汽化消融效率逐渐提高,且汽化量和消耗总能量之间呈良好的线性相关(P<0.001)。病理组织学HE染色结果显示实验组的凝固层厚度为292.20~309.98μm,汽化层深度为1.49~4.52 mm;同类对照组的凝固层厚度为289.91~303.53μm,汽化层深度为1.88~4.43 mm,两组间比较均未见明显差异(P>0.05)。同时,汽化切割截面积为1 cm2的离体猪肾组织时,60~160 W的1470 nm半导体激光对肾组织的汽化切割效率随输出功率的增大而提高(P<0.05),其中实验组的凝固层厚度为496.04~514.47μm,同类对照组的凝固层厚度为489.39~518.53μm。此外,凝结模式下30、40、50 W的半导体激光对离体猪肾组织照射5、10、15 s时,随着激光输出功率的增加,凝固瘢直径、凹槽深度和凝固效率均逐渐增大(P<0.05);其中实验组和同类对照组的凝固层厚度分别为399.10~449.98μm和392.97~447.65μm,汽化层深度分别为3.05~7.09 mm和2.70~7.14 mm,两组间比较均未见明显差异(P>0.05)。结论1470 nm半导体激光对离体动物组织具有良好的汽化消融、切割和凝固作用,其效果与输出能量之间具有良好的线性相关。

450 nm蓝激光汽化术治疗良性前列腺增生患者30例初步经验

目的分析450 nm蓝激光汽化术治疗良性前列腺增生(BPH)患者的临床效果并总结初步经验。方法选取2023年6—9月青海红十字医院泌尿外科收治的接受经尿道450 nm蓝激光汽化术治疗的30例BPH患者的临床资料。记录手术操作时间、血红蛋白下降值、膀胱冲洗时间、导尿管留置时间及并发症发生情况。比较患者术前、术后3个月的国际前列腺症状评分(IPSS)、生活质量评分(QoL)、膀胱残余尿量(PVR)和最大尿流率(Qmax)指标变化。结果患者均顺利完成手术,术中无中转经尿道前列腺电切术(TURP)及开放手术。手术操作时间(38.2±7.5)min,术后24 h血红蛋白下降值(10.4±3.5)g/L,膀胱冲洗时间(15.1±3.3)h,导尿管留置时间(4.5±0.5)d。相较于术前,术后3个月患者的IPSS[(26.28±2.22)分vs.(6.29±2.10)分]、QoL[(5.25±0.85)分vs.(2.33±0.95)分]、PVR均显著降低[(397.89±8.47)mL vs.(15.62±2.17)mL],Qmax显著升高[(8.15±2.09)mL/s vs.(19.50±2.51)mL/s],差异均具有统计学意义(P<0.05)。术中膀胱黏膜轻度损伤2例(6.6%),术后二次留置导尿管1例(3.3%),术后肉眼血尿1例(3.3%),未发生严重并发症。结论采用450 nm蓝激光汽化术治疗BPH患者具有快速高效、止血可靠、并发症低的优点,可有效改善患者排尿情况,值得临床推广应用。

over-night模式下日间经尿道钬激光前列腺剜除术的围手术期安全性与可行性研究

目的 评估over-night模式下日间经尿道钬激光前列腺剜除术(HoLEP)的围手术期安全性与可行性。方法 回顾性分析2021年1月-2023年3月该院83例良性前列腺增生(BPH)患者的临床资料,由同一术者完成HoLEP治疗。根据围手术期管理方法不同分为over-night日间HoLEP组(over-night组,43例)和普通HoLEP组(普通组,40例),根据前列腺体积分为大体积组(≥50 mL)与小体积组(<50 mL)。记录所有患者的年龄和围手术期资料[前列腺总体积、前列腺切除重量、切除标本比例、手术时间、外周静脉血血红蛋白(Hb)变化、膀胱冲洗时间、带尿管时间和首次拔管成功率等],并对各组间的参数进行比较。结果 83例患者均未出现HoLEP相关的再次手术和再入院情况;over-night组中,年龄57~90岁,平均(70.1±7.3)岁,前列腺体积29~161 mL,平均(63.0±28.8) mL,全部顺利完成流程,均在24 h内办理出院,无中转普通组病例,首次拔管成功率为88.4%(38/43),平均带管时间(17.8±3.6) h;普通组中,年龄55~87岁,平均(70.4±8.2)岁,前列腺体积22~118 mL,平均(59.4±29.0) mL,平均带管时间(77.5±25.1) h,首次拔管成功率为90.0%(36/40);两组患者前列腺总体积、前列腺切除重量、切除标本比例、手术时长、外周静脉血Hb变化、膀胱冲洗时间和首次拔管成功率比较,差异均无统计学意义(P> 0.05),带尿管时间比较,差异有统计学意义(P <0.01)。结论 无论前列腺体积大小,日间HoLEP均是安全和可行的;over-night模式下的日间HoLEP,适合在国内广泛开展,尤其在HoLEP手术经验丰富的医疗中心,可常规开展。

450 nm半导体蓝激光前列腺汽化切除术治疗40例良性前列腺增生患者的疗效观察

目的评估450 nm半导体蓝激光前列腺汽化切除术治疗良性前列腺增生(BPH)的手术疗效及安全性。方法回顾性分析皖南医学院第二附属医院泌尿外科2023年3—11月40例采用450 nm半导体蓝激光前列腺汽化切除术治疗的BPH患者临床资料,比较患者手术前后的最大尿流率(Qmax)、残余尿量(PVR)、国际前列腺症状评分(IPSS)、生活质量评定量表(QoL)评分变化及手术时间、术后膀胱冲洗时间和术后血红蛋白下降值。结果40例患者均顺利完成手术。患者术后1月Qmax明显高于术前[(16.8±2.5)mL/s vs.(7.9±2.1)mL/s,P<0.05],术后PVR明显低于术前[(14.6±11.4)mL vs.(110.0±42.1)mL,P<0.05],术后IPSS[(11.8±4.0)分vs.(25.0±3.1)分,P<0.05]及QoL评分均明显低于术前[(2.5±0.6)分vs.(5.1±0.9)分,P<0.05]。患者手术时间(52.5±15.5)min,术后膀胱冲洗时间(22.3±4.9)h,术后血红蛋白下降值(6.5±3.8)g/L。2例患者拔除尿管后再次予以导尿,1例患者出院后出现血尿。结论450 nm半导体蓝激光前列腺汽化切除术可显著改善BPH患者的临床症状,提高围手术期的安全性,具有汽化效率高、止血效果好等特点,值得在临床推广应用。

1470 nm激光DiLEP手术对良性前列腺增生患者围术期指标及IPSS评分的影响

目的:探究1470 nm激光半导体激光前列腺剜除术(DiLEP)对良性前列腺增生患者围术期指标及国际前列腺症评分(IPSS)的影响。方法:选取新密市中医院72例良性前列腺增生患者为研究对象,以随机数字表法分为A组、B组,各36例,分别实施经尿道前列腺电切术和1470 nm激光DiLEP术治疗,比较两组围术期指标、前列腺特异性抗原(PSA)水平、尿动力学指标、IPSS评分、勃起功能及并发症发生率。结果:B组手术时间、并发症发生率与A组相近,差异无统计学意义(P>0.05);B组血钠下降水平较A组低,膀胱冲洗时间、留置导尿管时间较A组短(P<0.05);术后7 d时B组PSA水平较A组高,术后3个月B组最大尿流(Qmax)水平、国际勃起功能指数-5(IIEF-5)评分较A组高,残余尿量(PVR)水平、IPSS评分较A组低,差异有统计学意义(P<0.05)。结论:对良性前列腺增生患者实施1470 nm激光DiLEP手术治疗,与应用经尿道前列腺电切术相比,可维持其血钠稳定,缩短术后康复时间,减轻前列腺损伤,改善其排尿、勃起功能及前列腺功能,且安全性良好。