Intervention Review

Laser prostatectomy for benign prostatic obstruction

  1. Richard M Hoffman1,*,
  2. Roderick MacDonald2,
  3. Timothy Wilt2

Editorial Group: Cochrane Prostatic Diseases and Urologic Cancers Group

Published Online: 24 JAN 2000

Assessed as up-to-date: 28 SEP 1999

DOI: 10.1002/14651858.CD001987.pub2

How to Cite

Hoffman RM, MacDonald R, Wilt T. Laser prostatectomy for benign prostatic obstruction. Cochrane Database of Systematic Reviews 2000, Issue 1. Art. No.: CD001987. DOI: 10.1002/14651858.CD001987.pub2.

Author Information

  1. 1

    New Mexico VA Health Care System, General Internal Medicine 111GIM, Albuquerque, New Mexico, USA

  2. 2

    VAMC, General Internal Medicine (111-0), Minneapolis, MN, USA

*Richard M Hoffman, General Internal Medicine 111GIM, New Mexico VA Health Care System, 1501 San Pedro Drive SE, Albuquerque, New Mexico, 87108, USA. rhoffman@unm.edu.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 24 JAN 2000

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Symptomatic benign prostatic obstruction is a common problem for older men. The gold standard treatment, transurethral resection of the prostate (TURP), significantly improves urinary symptoms and urinary flow. However, TURP has up to a 20% morbidity. Currently, there are a number of minimally invasive procedures that may be safe, effective alternatives to TURP. One promising surgical technique is laser prostatectomy.

Objectives

To assess the therapeutic efficacy and safety of laser prostatectomy techniques for treating men with symptomatic benign prostatic obstruction.

Search methods

Randomized controlled trials were identified from the Cochrane Collaboration Library, MEDLINE, EMBASE, bibliographies of retrieved articles and reviews, and contacting expert relevant trialists and laser manufacturers.

Selection criteria

All randomized controlled trials evaluating laser prostatectomy treatment for men with symptomatic BPH. Trials were eligible if they (1) were randomized comparisons of a laser technique with TURP, (2) included at least 10 men with BPO in each treatment arm, (3) provided at least 6-months follow-up, and (4) included clinical outcomes such as urologic symptom scales or urodynamic measurements.

Data collection and analysis

Data extraction and assessment of methodologic quality was performed independently by two reviewers. Information on study design, subject and treatment characteristics, adverse events, urinary symptoms, and urinary flow were extracted using a standard form.

Main results

Twenty studies involving 1898 subjects were evaluated, including 4 studies with multiple comparisons. We found eight comparisons of TURP with contact lasers, eight with non-contact lasers, four with hybrid techniques, and one with interstitial laser coagulation (ILC). Two studies compared transurethral electrovaporization (TUVP) with contact lasers, one study compared interstitial laser coagulation with transurethral microwave thermotherapy (TUMT), and one study compared holmium contact lasers (HoLRP) with open prostatectomy. Among the studies comparing laser prostatectomy with TURP, follow-up duration ranged from 6 to 36 months. Mean age (67.2 yrs), mean baseline symptom score (20.2), and mean baseline peak urinary flow (9.2 mL/s) did not differ by treatment group. The pooled percentage improvements for mean urinary symptoms ranged from 59% to 68% with lasers and 63% to 77% with TURP. The improvements for mean peak urinary flow ranged from 56% to 119% with lasers and 96% to 127% with TURP. Overall, laser subjects were less likely to receive transfusions or develop strictures and their hospitalizations were shorter. Non-contact laser subjects were more likely to have dysuria, urinary tract infection, and retention. Re-operation occurred more often following laser procedures.

Authors' conclusions

Laser techniques are a useful alternative to TURP for treating BPO. Small sample sizes and differences in study design limit any definitive conclusions regarding the preferred type of laser technique. Data were insufficient to compare laser techniques with other minimally invasive procedures.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Laser prostatectomy for benign prostatic obstruction

Bothersome lower urinary tract symptoms (LUTS) associated with benign prostatic obstruction (BPO) is a common problem for older men.  LUTS can be both irritative (urgency, frequency, frequent nighttime urinations) and obstructive (weak stream, hesitancy, intermittency, and feeling the bladder is not emptied).  Transurethral resection of the prostate (TURP) is considered the gold standard treatment for symptomatic BPO.  TURP improves urinary symptoms and urinary flow by surgically removing prostatic tissue through the urethra.  However, side effects occurring in approximately 20% of all TURPs include blood loss requiring transfusion, infections, strictures, sexual dysfunction, urinary incontinence, and urinary retention.  Laser prostatectomy, which uses a laser to destroy the enlarged prostate tissue that leads to LUTS, is a minimally invasive procedure currently used as an alternative to TURP.  This review of 20 studies involving 1898 subjects found laser techniques to be useful and relatively safe alternatives to TURP.  The small number of enrolled subjects and differences in study design limit any definitive conclusions regarding which type of laser technique is the most effective.  Improvements in LUTS and urine flow slightly favored TURP, though laser procedures had fewer side effects and shorter hospitalization times.  The follow-up durations of these studies ranged from 6 to 36 months and men with extremely large prostates were generally excluded from the trials. The risk of needing a reoperation for recurrent LUTS was higher following laser procedures. Study results were insufficient to adequately compare laser techniques with other minimally invasive procedures. More studies, using randomized treatment assignment, enrolling larger numbers of subjects, and comprehensive measures of treatment effectiveness and side events, are needed to better define the long-term safety and durability of laser techniques for treating LUTS associated BPO.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

以雷射前列腺切除術治療良性前列腺阻塞

有症狀之良性前列腺阻塞症為年長男性之常見疾病。經尿道前列腺切除術(TURP)為其標準治療方法,可以顯著改善泌尿症狀及尿流問題,然而,經尿道前列腺切除術有高達20%的併發症。目前有一些比經尿道前列腺切除術更為安全且有效之低侵襲性療法,雷射前列腺切除術即為一充滿希望之外科技術。

目標

旨在評估以雷射前列腺切除技術,在治療有症狀之良性前列腺阻塞症男性身上之治療效果與安全性。

搜尋策略

由Cochrane Collaboration Library、MEDLINE及EMBASE等資料庫,以及可取得之文章與回顧,所得到之隨機對照試驗,並與相關之臨床試驗執行者及雷射製造廠商相互聯繫。

選擇標準

所有用於治療有症狀之良性前列腺肥大男性之雷射前列腺切除術的隨機對照試驗。試驗需符合下述條件:(1)隨機分配之雷射技術與經尿道前列腺切除術的比較、(2)任一治療方式包含至少10位良性前列腺阻塞男性、(3) 追蹤期至少6個月以上以及(4)需包括臨床結果,如相關泌尿症狀評分或尿路動力學測量。

資料收集與分析

資料的擷取與方法學上品質的評估,由兩位審查人獨立執行,並採用標準格式擷取關於研究設計、試驗對象與治療特色、不良反應、泌尿症狀與尿流速等資訊。

主要結論

總計20項研究共評估1898名對象,其中4項研究為多重比較。我們總共比較8個經尿道前列腺切除術與接觸式雷射,8個非接觸式雷射,4個複合式技術,以及1個間質性雷射凝固術(interstitial laser coagulation)。有兩項研究對經尿道前列腺電氣化術與接觸式雷射進行比較,一項研究係比較間質性雷射凝固術與經尿道微波熱療法,並有一項研究係比較鈥雷射(holmium contact laser)與開放式前列腺摘除術之差異。在各項比較雷射前列腺切除術與經尿道前列腺切除術的研究中,追蹤期持續達6至36個月。平均年齡(67.2歲)、平均基準症狀分數(20.2),以及平均基準最大尿流速(9.2毫升/秒)在治療組中皆無差異。就泌尿症狀之綜合改善百分比看來,雷射治療為59%至68%,經尿道前列腺切除術則為63%至77%。有關平均最大尿流速的改善情況,雷射治療為56%至119%,而經尿道前列腺切除術則從96%至127%。整體而言,接受雷射治療者較不需要輸血或發生狹窄,其住院天數也較短。接受非接觸式雷射治療者,則有較高的可能性出現解尿疼痛、尿道感染以及尿滯留等現象。雷射治療後較常發生再手術的情況。

作者結論

在良性前列腺阻塞的治療上,雷射技術為經尿道前列腺切除術外另一種有效之選擇。研究設計中之小樣本數與差異,限制了任何有關偏好雷射技術種類之明確結論,資料也不足以比較雷射技術與其他低侵襲性治療。

翻譯人

本摘要由臺灣大學附設醫院陳億聲翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

無總結。