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Operative Therapie der benignen Prostatahyperplasie – Versorgungsrealität und Outcome

Surgical treatment of benign prostatic hyperplasia—outcome in a real life setting

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Journal für Urologie und Urogynäkologie/Österreich Aims and scope

Zusammenfassung

Zielsetzung

Die TUR-P gilt nach wie vor als Referenzverfahren in der Behandlung der gutartigen Prostataobstruktion (BPO); die Grünlicht-Laser-Vaporisation (PVP) und die Thulium-Laser-Vapoenukleation (ThuVEP) sind inzwischen ebenfalls etablierte Therapieverfahren. Ziel dieser prospektiven Untersuchung ist der Vergleich dieser Verfahren in der täglichen Routine anhand eines ungefilterten großen Patientenkollektivs.

Methoden

Diese prospektive multizentrische Datenerhebung untersucht die Morbidität, den perioperativen Verlauf und das postoperative Follow-up nach transurethraler Intervention zur Therapie des BPO an einem konsekutiven Patientenkollektiv, das zwischen 2011 und 2014 in der Metropolregion Hamburg mit TUR-P, PVP oder ThuVEP behandelt wurde. Der postoperative Verlauf wurde durch das Versenden von Fragebögen an die Patienten ermittelt („patient-related outcome measurement“ [PROM]).

Ergebnisse

Im erfassten Zeitraum wurden 2648 Patienten behandelt. Mit allen Verfahren wurde die sofortige Verbesserung der Miktionsparameter erreicht. Die multivariate Analyse bestätigte eine Verkürzung der Liegezeit durch den Einsatz von Laserverfahren (p < 0,001). Patienten unter fortgesetzter gerinnungsbeeinflussender Medikation hatten eine verlängerte Verweildauer (p < 0,001). Perioperative Komplikationen und Reinterventionen (Clavien 3b) waren in der PVP-Gruppe am seltensten (p = 0,016; p < 0,001). Das durchschnittliche Follow-up betrug 3,2 Jahre. Die Rücklaufquote der Fragebögen betrug 60,7 %. Der IPSS fiel in der TUR-P-, PVP- und ThuLEP-Gruppe auf 7,6; 7,1 und 5,9 ab. Die IPSS-Reduktion war in der ThuVEP-Gruppe am stärksten ausgeprägt (p < 0,001). In der TUR-P- und in der PVP-Gruppe verbesserte sich die QoL auf 1,72 bzw. 1,66, in der ThuVEP-Gruppe auf 1,3. Auch dieser Unterschied ist signifikant (p < 0,001).

Schlussfolgerung

Die transurethrale abladierende Therapie der BPO ist bei allen untersuchten Verfahren sicher und effektiv möglich. Die Volumenreduktion ist bei der ThuVEP am größten. Die PVP hat die niedrigste Komplikationsrate. Die Laserverfahren führen zu einer verkürzten Krankenhausverweildauer. Die hohe Rücklaufquote macht PROM zu einem zuverlässigen Instrument. IPSS und QoL wurden durch alle Verfahren signifikant verbessert. Die ThuVEP erzielte den stärksten Effekt.

Abstract

Purpose

Transurethral resection of the prostate (TUR-P) is considered the reference method for surgical treatment of benign prostatic obstruction (BPO); greenlight laser photoselective vaporization (PVP) and thulium laser vapoenucleation (ThuVEP) have also been established as treatments of BPO. The aim of this prospective observation was to compare these methods in a large number of patients treated in daily routine.

Methods

This prospective multicentre data collection was used to assess morbidity and perioperative course of consecutive men treated with BPO-related transurethral surgery between 2011 and 2014 in the German metropolitan area of Hamburg with TUR-P, PVP or ThuVEP. The postoperative course was evaluated by questionnaires sent to the patients (patient-related outcome measurement: PROM).

Results

During this time period, 2648 patients were treated. All treatment options achieved immediate improvement of voiding parameters. Multivariate analyses proved shorter hospital stay after laser treatments as compared to resection (p < 0.001). Patients with ongoing anticoagulation or bridging had a prolonged hospital stay (p < 0.001). Overall adverse events were least frequent in PVP (p = 0.016), as were Clavien 3b events (p < 0.001). The mean duration of follow-up was 3.2 years. The questionnaire response rate was 60.7%. IPSS dropped in the TUR-P, PVP and ThuVEP groups to 7.6, 7.1 and 5.9 respectively. The ThuVEP group had the strongest decrease in IPSS (p < 0.001). Postoperative quality of life (QoL) was 1.72 and 1.66 in the TUR-P and PVP groups. In the ThuVEP group it was 1.3 (p < 0.001).

Conclusion

Surgical treatment of BPO is effective and safe independent of the surgical procedure. Volume reduction is most effective in ThuVEP; PVP has the lowest rate of severe complications. Laser treatment is associated with shorter hospital stay. Due to the high return rate PROM is a reliable instrument. IPSS and QoL are improved by all interventions. ThuVEP showed the strongest effect.

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Authors and Affiliations

  1. Abteilung für Urologie, Asklepios Westklinikum Hamburg GmbH, Suurheid 20, 22559, Hamburg, Deutschland

    C. Brunken & T. Pottek

  2. Urologische Abteilung, Asklepios Klinik Hamburg, Eißendorfer Pferdeweg 52, 21075, Harburg, Deutschland

    F. Wölbling & T. Bach

  3. Urologische Abteilung, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland

    A. J. Gross & C. Netsch

  4. Urologische Abteilung, Asklepios Klinik Wandsbek, Alphonsstr. 14, 22043, Hamburg, Deutschland

    S. Tauber

  5. Urologische Abteilung, Asklepios Klinik Altona, Paul-Ehrlich Str. 1, 22763, Hamburg, Deutschland

    C. Wülfing

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  1. C. Brunken
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Correspondence to C. Brunken.

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Interessenkonflikt

C. Brunken, F. Wölbling, A.J. Gross, C. Netsch, S. Tauber, T. Pottek, C. Wülfing und T. Bach geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Von allen an der Befragung Beteiligten liegt eine schriftliche Einverständniserklärung vor. Die Zustimmung der zuständigen Ethikkommission liegt vor.

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Brunken, C., Wölbling, F., Gross, A.J. et al. Operative Therapie der benignen Prostatahyperplasie – Versorgungsrealität und Outcome. J. Urol. Urogynäkol. AT 26, 56–65 (2019). https://doi.org/10.1007/s41972-018-0057-8

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  • DOI: https://doi.org/10.1007/s41972-018-0057-8

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