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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 鄧子麒 | 前列腺水蒸汽消融治療（Rezum）和前列腺尿道拉提手術（UroLift）的比較：為期兩年的前瞻性研究 | 2025/1/24 下午 05:40:02 | 0 |
| 原 文 | 題 目 | Convective Water Vapor Energy Ablation (Rezum® ) Versus Prostatic Urethral Lift (Urolift® ): A 2-Year Prospective Study |
| 作 者 | Yu Xi Terence Law, BSc, MBBS, MRCS, MCI, 1 Wei Jing Kelven Chen, MBBS, MRCS, MCI, MMED, FAMS,1 Liang Shen, BSc, MSc, PhD, 2 Kyaw Lin, MBBS, MRCS, 1 Chloe Shu Hui Ong, MBBS, MRCS,1 Qi Yang Lim, MBBS, MRCS, 1 Gregory Xiang Wen Pek, MBBS, MRCS, 1 Woon Chau Tsang, MBBCh, FRCS,1 Yi Quan Tan, MBBS, MRCS, MMED, FAMS, FRCS, 1,3 Jun Yang Chia, MBBS, MCI, MRCS, MMED, FAMS,1 King Chien Joe Lee, MBBS, MRCS, MMED, FAMS, 1,4and Wei Jin Chua, MBChB, MRCS, MMED, FAMS1 | |
| 出 處 | J Endourol . 2024 Dec;38(12):1387-1394. doi: 10.1089/end.2024.0400. Epub 2024 Oct 1. | |
| 出版日期 | December 13, 2024 | |
| 評 論 |
這是一篇由新加坡的單一醫學中心所做的研究，比較前列腺水蒸汽消融治療（Rezum）和前列腺尿道拉提手術（UroLift）以華人為主的患者族群治療後追蹤兩年比較臨床效果及併發症率，並分析導致這兩種治療方式失敗的預測因素。從 2019 年 10 月至 2022 年 10 月，共有 86 名患者接受了Rezum，62 名患者接受了Urolift。與Urolift相比，Rezum需要更長的導尿管留置時間（12.38 ± 5.548 天對比 1.39 ± 3.010 天，p < 0.001）。Rezum的併發症發生率更高（41.9% 對比 16.1%，p < 0.001），其中包括血尿（19.8% 對比 6.5%，p = 0.022）及尿路感染（31.4% 對比 4.8%，p < 0.001）。在 Clavien–Dindo 分級 3–5 的嚴重併發症發生率上，兩者無顯著差異。Urolift的再手術率較高（8.1% 對比 0%，p = 0.010）。Rezum術後需要使用抗膽鹼藥物的比例較高（25.6% 對比 12.9%，p = 0.024）。兩種手術在改善國際前列腺症狀評分（IPSS）、生活品質（QOL）及最大尿流速（Qmax）方面，兩年追蹤的效果相當，且無顯著差異。術前 IPSS ≥16 預測治療失敗的敏感性為 95.7%，特異性為 38.4%。
結論：Rezum和Urolift在改善患者臨床症狀方面無顯著差異。然而，接受Rezum的患者出現更多輕微併發症，且術後更需要使用抗膽鹼藥物。Urolift則有較高的再手術率。對於術前 IPSS ≥16 的患者，這兩種治療方式的效果可能有限。 |
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| abstract |
Introduction: To compare the clinical outcomes and complication rates of convective water vapor energy ablation (Rezum ® ) and prostatic urethral lift (Urolift ® ). To identify predictive factors for treatment failures in both treatments.
Materials & Methods: Prospective clinico-epidemiological data of patients who underwent Urolift ® or Rezum ® in a single institution for benign prostatic hyperplasia (BPH) was collected. The choice of intervention depended on the preference of the patients after patient-centric discussions. Results: From October 2019 to October 2022, 86 patients underwent Rezum ® , and 62 patients underwent Urolift ® . Rezum ® involved a longer indwelling catheter duration (12.38 – 5.548 vs 1.39 – 3.010 days, p < 0.001) compared with Urolift ® . Rezum ® was associated with more complications compared with Urolift ® (36 [41.9%] vs 10 [16.1%] cases, p < 0.001). Rezum ® had more cases of hematuria (17 [19.8%] vs 4 [6.5%] cases [p = 0.022]) and urinary tract infections (27 [31.4%] vs 3 [4.8%] cases, p < 0.001) compared with Urolift ® . There were no significant differences in Clavien–Dindo Grade 3–5 complications between the interventions. Urolift ® was associated with higher reoperation rates (5 [8.1%] vs 0 [0%] cases, p = 0.010) compared Rezum ® . Rezum ® had higher anticholinergic usage rates compared with Urolift ® post-operation (22 [25.6%] vs 8 [12.9%] cases, p = 0.024). Both interventions showed improvement in the International Prostate Symptom Score (IPSS), quality of life score, and peak velocity flow over the 2 years with no significant difference between the two. Based on receiver operating characteristic curve, preoperation IPSS ‡16 had 95.7% sensitivity and 38.4% specificity to predict the probability of treatment failures after the interventions. Conclusions: There was no difference in clinical outcomes of patients who underwent Rezum ® and Urolift ® . However, patients who had undergone Rezum ® faced more minor complications and more required anti-cholinergic medications. Lastly, physicians should note that patients with IPSS ≥16 would unlikely benefit from either intervention. |
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