Early Clinical Experience with Transurethral Electrovaporization of the Prostate for Benign Prostatic Hyperplasia: Comparison with Transurethral Resection of the Prostate and Visual Laser Ablation of the Prostate

경요도전립선전기기화술의 초기 임상경험 : 경요도전립선절제술 및 레이저 전립선절제술과의 비교

Recently, several alternatives have been attempted in the management of benign prostatic hyperplasia (BPH) to reduce morbidity of traditional transurethral resection of the prostate (TURP). Among new modalities, transurethral electrovaporization (TEVP) is considered as a promising alternative. To evaluate the safety and initial efficacy of JEVP using the roller loop electrode (ProSurg Inc. USA) on BPH patients, we compared the results of TEVP with those of TURP and visual laser ablation of the prostate (VLAP). In this study, a total of 115 patients with symptomatic BPH were underwent TEVP (n=17), TURP (n=59) or VLAP (n=39) since 1995. Before treatment, patients were evaluated with an International Prostate Symptom Score (IPSS) and the measurement of maximal uroflow rate (MFR) and postvoid residual urine (PVR). After treatment, the operative and hospital records were reviewed. The uroflowmetry and IPSS were re-evaluated 3-10 months after treatment. In clinical outcome of re-evaluation compared to the preoperative parameters, there was a clinically significant improvement in three procedures. TEVP resulted in 62% reduction in IPSS (TURP, 73% : VLAP, 69%), 84% improvement in MFR (TURP, 113% : VLAP, 91%), and 74% reduction in PVR (TURP, 88% : VLAP, 78%). TEVP had shorter duration of hospitalization and catheterization than the others. TEVP was associated with lower rates of treatment-related complication than TURP. In conclusions, TEVP is considered as a useful procedure to treat symptomatic BPH. And, the advantages of TEVP over TURP include excellent intraoperative hemostasis, lower morbidity, shorter hospital stay and simple technique. In addition the advantages over VLAP include lower cost, shorter duration of catheterization and early symptom improvement.

최근에 Roller loop electrode를 이용한 경요도전립선전기기화술에 관심이 집중되고 있다. 저자들은 전립선비대증에서 전립선전기기화술의 가치를 알아보기 위해 Roller loop electrode를 이용한 전립선전기기화술(TEVP, 17례)을 레이저전립선절제술(VLAP, 39례)과 전통적 경요도전립선절제술(TURP, 59례)과 비교 분석해 보았다. TEVP는 효과 면에서는 전통적인 경요도전립선절제술에는 미치진 못하지만 VLAP과는 유사한 효과를 보였으며 안전성면과 경제적인 면에서는 VLAP을 능가하는 치료법으로 사료된다. 본 연구가 적은 환자를 대상으로 10개월까지 관찰한 결과이고 경요도전립선전기기화술의 초기 경험이라 명확한 결론을 내리기에는 다소 성급한 면이 있으나 전통적인 전립선절제술에 비해 짧은 입원기간, 짧은 요도관유치 기간 및 적은 출혈 등을 보여주며 레이저 시술의 단점인 고가장비가 필요 없다는 점에서는 전통적 전립선절제술의 대체 술기로 높이 평가되어진다.