針對攝護腺肥大病人進行銩雷射剜除手術與傳統刮除手術之比較：
單一醫學中心術後功能性結果分析

謝博彥^1,2、裘坤元¹、王賢祥¹、陳卷書¹、楊晨洸¹、盧嘉文¹、洪晟鈞¹、李建儀¹

¹台中榮民總醫院 泌尿部；²臺北醫學大學 醫學系

Comparison of Thulium Laser Enucleation and Conventional transurethral resection among BPH patients: Single center study of functional outcome

Po-Yen Hsieh^1,2, Kun-Yuan Chiu¹, Shian-Shiang Wang¹, Chuan-Shu Chen¹, Cheng-Kuang Yang¹, Kevin Lu¹, Sheng-Chun Hung¹, Jian-Ri Li¹*

¹Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan;

 ²School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan;

Purpose: Benign prostatic hyperplasia (BPH) is one of the most common conditions that afflicts 50% of men aged more than 50 years. Lower urinary tract symptoms (LUTS) associated with BPH can be treated with behavioral, pharmacological, and surgical interventions. Pharmacological treatment with Alpha blockers can reduce both storage and voiding LUTS. Antispasmodics as Muscarinic receptor antagonists and Beta-3 agonist can inhibit involuntary detrusor muscle contractions. Surgical intervention is the most effective treatment for BPH. Monopolar TURP had become the standard treatment for decades since the early 20th century. With the development of technology, multiple laser treatments, energy device, and surgical methods had evolved over the past 10 years. This study aimed to analysis the efficacy and post-operative functional outcome between Thulium Laser Enucleation and Conventional TURP with either laser or Bipolar energy.

Materials and Methods: We had reviewed our database and enrolled 818 patients, of which 218 were excluded due to neoplasm and missing data, who underwent ThuLEP and TURP from January 2019 to December 2021 in our institution. Among these patients, 91 underwent ThuLEP, 162 underwent B-TURP, and 347 underwent laser TURP. ThuLEP had been done by a single surgeon. Patients’ demographics, comorbidities, medical and operative history, pre-operative prostate volumes and urodynamic study were recorded. Perioperative outcomes about resected prostate volume ratio and the rate of reuse the BPH medications with Alpha blockers and Antispasmodics were also evaluated.

Results: The mean prostate size was greater for ThuLEP comparison to B-TURP and laser TURP (47 vs 34 vs 37 ml, P=0.033). Postoperative usage of Alpha blockers was significantly associated with Chronic kidney disease (OR = 1.93, 95% CI 1.04-3.56, p = 0.036) and Resected prostate volume ratio (OR = 0.67, 95% CI 0.31-1.11, p = 0.008). Moreover, postoperative usage of Antispasmodics was significantly associated with Diabetes (OR = 2.01, 95% CI 1.47-3.01, p = 0.031) and B-TURP (OR = 1.53, 95% CI 1.02-2.13, p = 0.011).

Conclusion: Although patients underwent ThuLEP and laser TURP were older and had larger prostates, ThuLEP and laser TURP resulted in a more favorable functional outcome who required less antispasmodics resumption. Otherwise, patients with underlying disease of CKD and DM were more likely to require medication after surgery.