Initial experience with prostatic urethral lift versus enucleation of the prostate: a retrospective comparative study
Tóm tắt
This study aimed to assess initial results and patient characteristics of prostatic urethral lift (PUL) compared with those of bipolar transurethral enucleation of the prostate (TUEB) in the treatment of benign prostatic hyperplasia (BPH) in older patients. This retrospective study was conducted at a single institution and involved 25 consecutive patients with BPH who underwent PUL between April 2022 and May 2023. Patient characteristics, operative details, and pre- and postoperative symptom scores were evaluated. The results were compared with those of a previously reported TUEB group (n = 55). The mean age of the patients in the PUL group was 74.6 years, and the mean prostate volume was 47.5 ml. The PUL procedure significantly improved urinary symptoms, particularly incomplete emptying (p = 0.041), intermittency (p = 0.005), and weak stream (p = 0.001). The PUL group had higher comorbidity scores (p = 0.048) and included older patients (p = 0.002) than the TUEB group. TUEB showed better improvements in some symptoms and maximum flow rate (p = 0.01) than PUL; however, PUL had a shorter operative time and fewer complications than TUEB (p < 0.001). The initial results demonstrate the efficacy and safety of PUL in older patients with BPH. Despite TUEB showing better outcomes in certain aspects than PUL, PUL offers advantages such as shorter operative time and fewer complications. Therefore, PUL can be considered a viable option for high-risk older patients with BPH.
Tài liệu tham khảo
Collaborators GBDBPH. The global, regional, and national burden of Benign Prostatic Hyperplasia in 204 countries and territories from 2000 to 2019: a systematic analysis for the global burden of Disease Study 2019. Lancet Healthy Longev. 2022;3(11):e754–76.
Cindolo L, Pirozzi L, Fanizza C, Romero M, Tubaro A, Autorino R, De Nunzio C, Schips L. Drug adherence and clinical outcomes for patients under pharmacological therapy for lower urinary tract symptoms related to Benign Prostatic Hyperplasia: population-based cohort study. Eur Urol. 2015;68(3):418–25.
Dahm P, Brasure M, MacDonald R, Olson CM, Nelson VA, Fink HA, Rwabasonga B, Risk MC, Wilt TJ. Comparative effectiveness of newer medications for lower urinary tract symptoms attributed to Benign Prostatic Hyperplasia: a systematic review and Meta-analysis. Eur Urol. 2017;71(4):570–81.
Mukai R, Shimada K, Suzuki T, Nakao S, Tanaka M, Matsumoto K, Yoshida Y, Goto F, Inoue M, Satake R, et al. Trends Associated with hemorrhoids in Japan: Data Mining of Medical Information datasets and the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open Data Japan. Biol Pharm Bull. 2020;43(12):1831–8.
Woo HH, Chin PT, McNicholas TA, Gill HS, Plante MK, Bruskewitz RC, Roehrborn CG. Safety and feasibility of the prostatic urethral lift: a novel, minimally invasive treatment for lower urinary tract symptoms (LUTS) secondary to Benign Prostatic Hyperplasia (BPH). BJU Int. 2011;108(1):82–8.
Hirasawa Y, Ide H, Yasumizu Y, Hoshino K, Ito Y, Masuda T. Comparison of transurethral enucleation with bipolar and transurethral resection in saline for managing Benign Prostatic Hyperplasia. BJU Int. 2012;110(11 Pt C):E864–869.
Sato K, Obinata D, Funakoshi D, Saito F, Takada S, Ito A, Murata Y, Ashikari D, Ikado Y, Igarashi T, et al. Efficacy of transurethral prostate enucleation by bipolar system for patients with Benign Prostatic Hyperplasia. Minerva Urol Nefrol. 2016;68(4):337–41.
Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175–91.
Assel M, Sjoberg D, Elders A, Wang X, Huo D, Botchway A, Delfino K, Fan Y, Zhao Z, Koyama T, et al. Guidelines for reporting of statistics for Clinical Research in Urology. Eur Urol. 2019;75(3):358–67.
Masumori N, Tsukamoto T, Kumamoto Y, Miyake H, Rhodes T, Girman CJ, Guess HA, Jacobsen SJ, Lieber MM. Japanese men have smaller prostate volumes but comparable urinary flow rates relative to American men: results of community based studies in 2 countries. J Urol. 1996;155(4):1324–7.
Fukuta F, Masumori N, Mori M, Tsukamoto T. Internal prostatic architecture on transrectal ultrasonography predicts future prostatic growth: natural history of prostatic hyperplasia in a 15-year longitudinal community-based study. Prostate. 2011;71(6):597–603.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.
Bellera CA, Rainfray M, Mathoulin-Pelissier S, Mertens C, Delva F, Fonck M, Soubeyran PL. Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Ann Oncol. 2012;23(8):2166–72.
Roehrborn CG, Gange SN, Shore ND, Giddens JL, Bolton DM, Cowan BE, Brown BT, McVary KT, Te AE, Gholami SS, et al. The prostatic urethral lift for the treatment of lower urinary tract symptoms associated with prostate enlargement due to Benign Prostatic Hyperplasia: the L.I.F.T. Study. J Urol. 2013;190(6):2161–7.
Roehrborn CG, Barkin J, Gange SN, Shore ND, Giddens JL, Bolton DM, Cowan BE, Cantwell AL, McVary KT, Te AE, et al. Five year results of the prospective randomized controlled prostatic urethral L.I.F.T. study. Can J Urol. 2017;24(3):8802–13.
Homma Y, Yoshida M, Seki N, Yokoyama O, Kakizaki H, Gotoh M, Yamanishi T, Yamaguchi O, Takeda M, Nishizawa O. Symptom assessment tool for overactive bladder syndrome–overactive bladder symptom score. Urology. 2006;68(2):318–23.
Homma Y, Yoshida M, Yamanishi T, Gotoh M. Core lower urinary tract Symptom score (CLSS) questionnaire: a reliable tool in the overall assessment of lower urinary tract symptoms. Int J Urol. 2008;15(9):816–20.
Homma Y, Kakizaki H, Yamaguchi O, Yamanishi T, Nishizawa O, Yokoyama O, Takeda M, Seki N, Yoshida M. Assessment of overactive bladder symptoms: comparison of 3-day bladder diary and the overactive bladder symptoms score. Urology. 2011;77(1):60–4.
Fujimura T, Kume H, Tsurumaki Y, Yoshimura Y, Hosoda C, Suzuki M, Fukuhara H, Enomoto Y, Nishimatsu H, Homma Y. Core lower urinary tract symptom score (CLSS) for the assessment of female lower urinary tract symptoms: a comparative study. Int J Urol. 2011;18(11):778–84.
Magistro G, Chapple CR, Elhilali M, Gilling P, McVary KT, Roehrborn CG, Stief CG, Woo HH, Gratzke C. Emerging minimally invasive treatment options for male lower urinary tract symptoms. Eur Urol. 2017;72(6):986–97.
Sonksen J, Barber NJ, Speakman MJ, Berges R, Wetterauer U, Greene D, Sievert KD, Chapple CR, Montorsi F, Patterson JM, et al. Prospective, randomized, multinational study of prostatic urethral lift versus transurethral resection of the prostate: 12-month results from the BPH6 study. Eur Urol. 2015;68(4):643–52.
Gratzke C, Barber N, Speakman MJ, Berges R, Wetterauer U, Greene D, Sievert KD, Chapple CR, Patterson JM, Fahrenkrug L, et al. Prostatic urethral lift vs transurethral resection of the prostate: 2-year results of the BPH6 prospective, multicentre, randomized study. BJU Int. 2017;119(5):767–75.