Combination of channel-TURP and ILC versus standard TURP or ILC for elderly with benign prostatic hyperplasia: a randomized prospective trial.

摘要

PURPOSE: A prospective randomized controlled trial was performed in elderly patients with benign prostatic hyperplasia (BPH) to evaluate the clinical effectiveness of channel transurethral resection of the prostate (C-TURP) combined with an interstitial laser coagulation (ILC) technique during a 4-year follow-up period. METHODS: A total of 150 consecutive BPH patients were randomized to an ILC+C-TURP group (n = 50), an ILC group (n = 50) and a TURP group (n = 50). Urinary tract infection, acute urinary retention and retrograde ejaculation were monitored, and the retreatment rate, international prostate symptom score (IPSS) and maximum flow rate (Q(max)) were measured. RESULTS: A total of 142 patients completed the follow-up and were recruited for further analysis. At 1 month, the proportion of patients with urinary tract infection was similar between the C-TURP+ILC group and the TURP group (8.5 and 6.5%, p > 0.05), but significantly higher than that in the ILC group (51%, p < 0.001). Acute urinary retention was found in 30.6% of patients in the ILC group, but was not observed in the C-TURP+ILC and TURP groups. In the TURP group, the rate of retrograde ejaculation was significantly higher than that in the other 2 groups (p < 0.001). The retreatment rate was 8.5, 36.7 and 2.2% in the C-TURP+ILC, ILC and TURP groups, respectively (p < 0.001). When compared with baseline, the IPSS in the C-TURP+ILC, ILC and TURP groups was decreased by 70.6, 45.4, and 81.0%, respectively (ILC vs. C-TURP+ILC or TURP, p < 0.01) at the 48-month follow-up. One month after surgery, the Q(max) was significantly increased in the C-TURP+ILC group and the TURP group when compared with that at baseline (p < 0.01). The TURP group had the highest and the ILC group had the lowest increase in the Q(max) at the 12-, 24-, and 48-month follow-ups (p < 0.05). CONCLUSIONS: C-TURP+ILC is a safe and effective modality for the treatment of BPH, and exhibits favorable short-term clinical response and long-term durability. It is relatively reasonable and acceptable for treatment of high-risk elderly patients or those with a limited life expectancy.