180瓦綠光雷射汽化手術在攝護腺阻塞所伴隨的儲尿症狀的治療成效與預測因子

王彰德、高耀臨、莊明勳、黃元麒、歐穎謙

國立成功大學醫學院附設醫院 泌尿部

Therapeutic Efficacy of 180-W GreenLight XPS Vaporization of the Prostate for the Storage Symptoms Concomitant with Benign Prostatic Obstruction and a Search for Outcome Predictors

Chang-Te Wang、Yao-Lin Kao、Ming- Syun Chuang、Yuan-Chi Huang、Yin-Chien Ou

Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

Purpose: Benign prostatic obstruction (BPO) is the most common cause of lower urinary tract symptoms (LUTS), including both storage and voiding symptoms, in elderly males. Photoselective vaporization of the prostate (PVP) using 180-W GreenLight XPS (GL-XPS) laser system is a well-established surgical option which provides durable efficacy in relieving BPO-induced voiding symptoms. However, its therapeutic effect on storage symptoms was less mentioned and remains unclear. This study aims to analysis the therapeutic outcome of storage symptoms in patients underwent GL-XPS PVP for BPO, as well as to identify the outcome predictors for storage symptoms.

Materials and Methods: Patients receiving GL-XPS PVP for BPO from May 2018 to May 2021 were retrospectively reviewed. Clinical characteristics, baseline prostate volume, pre- and post-operative International Prostate Symptom Scores (IPSS), and parameters from pre-operative pressure-flow study were collected. The definition of successful storage outcome is defined as more than 50% improvement in the IPSS storage subscore (IPSS-S).

Results: A total of 73 male patients were included, with a mean age of 70.3 ± 9.4 years and a baseline prostatic volume of 75.4 ± 33.8 ml. The mean IPSS total score, IPSS-S, and voiding subscore (IPSS-V) were all significantly decreased at 6 months after GL-XPS PVP (p<0.001 for all). Fifty-two patients (71.2%) achieved the definition of successful storage outcome at 6 months. Multivariate analysis revealed that pre-operative IPSS storage-to-voiding subscore ratio (IPSS-S/V) ≥ 0.8 and detrusor underactivity are negative predictors for successful storage outcome (P=0.024 and 0.034, respectively), while the presence of detrusor overactivity is predictive for successful storage outcome (P=0.036).

Conclusion: GL-XPS PVP provides a good therapeutic outcome for the storage symptoms concomitant with BPO. Pre-operative IPSS-S/V ≥ 0.8 and detrusor underactivity suggest poor storage outcome, and the presence of detrusor overactivity indicates successful storage outcome.