【AUA指南更新】良性前列腺增生相关性下尿路症状的外科治疗

Guideline Statements

指南荟萃

Evaluation and Preoperative testing 

评估和术前检查

1. Clinicians should take a medical history and utilize the AUA-Symptom Index (AUA-SI) and urinalysis in the initial evaluation of patients presenting with bothersome LUTS possibly attributed to BPH; select patients may also require post-void residual (PVR), uroflowmetry, or pressure flow studies. (Clinical Principle)

1.对BPH相关的LUTS的患者进行初步评估，临床医生应详细了解病史，并通过AUA症状指数评分（AUA-SI）和尿检等进行分析；部分选择性患者可能需要进行残余尿、尿流率或压力/尿流率测定等检查。（临床原则）

2. Clinicians should consider assessment of prostate size and shape via abdominal or transrectal ultrasound, or cystoscopy, or by preexisting cross-sectional imaging (i.e. magnetic resonance imaging [MRI]/ computed tomography [CT]) prior to surgical intervention for LUTS attributed to BPH.  (Clinical Principle)

2.在BPH相关的LUTS行外科手术干预前，临床医生应通过经腹或经直肠超声、膀胱镜检查、或已有的横断面影像（即磁共振成像[MRI] /计算机断层扫描[CT]）评估前列腺大小和形状。（临床原则）

3. Clinicians should perform a PVR assessment prior to surgical intervention for LUTS attributed to BPH. (Clinical Principle)

3.对BPH相关的LUTS在外科手术干预前，临床医生应进行残余尿评估。（临床原则）

4. Clinicians should consider uroflowmetry prior to surgical intervention for LUTS attributed to BPH. (Clinical Principle)

4. 对BPH相关的LUTS行外科手术干预前，临床医生应考虑行尿流率测定。（临床原则）

5. Clinicians should consider pressure flow studies prior to surgical intervention for LUTS attributed to BPH when diagnostic uncertainty exists. (Expert Opinion)

5.当BPH相关的LUTS存在诊断不确定性时，临床医生在外科手术干预前应进行压力/尿流率测定。（专家意见）

Surgical therapy 

外科治疗

6.Surgery is recommended for patients who have renal insufficiency secondary to BPH, refractory urinary retention secondary to BPH, recurrent urinary tract infections (UTIs), recurrent bladder stones or gross hematuria due to BPH, and/or with LUTS attributed to BPH refractory to and/or unwilling to use other therapies. (Clinical Principle)

6.对继发于BPH的肾功能不全、顽固性尿潴留、复发性尿路感染(UTIs)、复发性膀胱结石或反复肉眼血尿，（以及/或）难治性的BPH相关性LUTS（和/或）不愿使用其他治疗方法的患者，建议手术治疗。（临床原则）

7. Clinicians should not perform surgery solely for the presence of an asymptomatic bladder diverticulum; however, evaluation for the presence of BOO should be considered. (Clinical Principle)

7.临床医生不应仅由于无症状膀胱憩室而进行手术；但对评估存在膀胱出口梗阻者（BOO）可考虑手术治疗。（临床原则）

Transurethral resection of the prostate (TURP)

经尿道前列腺电切术（TURP）

8. TURP should be offered as a treatment option for men with LUTS attributed to BPH. (Moderate Recommendation; Evidence Level: Grade B)

8.对于BPH相关的LUTS男性患者，TURP可作为治疗方法的选择。（中等推荐;证据级别：B级）

9. Clinicians may use a monopolar or bipolar approach to TURP, depending on their expertise with these techniques. (Expert Opinion)

9.根据临床医师（TURP）技术的专业能力，切割电极可使用单极或双极电刀。（专家意见）

Simple prostatectomy

单纯前列腺切除术

10. Clinicians should consider open, laparoscopic or robotic assisted prostatectomy, depending on their expertise with these techniques, for patients with large prostates. (Moderate Recommendation; Evidence Level: Grade C)

10.对于大体积前列腺患者，临床医生应根据他们技术专业水平，选择开放手术、腹腔镜或机器人辅助前列腺切除术。（中等推荐;证据级别：C级）

Transurethral inclsion of the prostate(TUIP)

经尿道前列腺切开术（TUIP）

11. TUIP should be offered as an option for patients with prostates ≤30g for the surgical treatment of LUTS attributed to BPH. (Moderate Recommendation; Evidence Level: Grade B)

11. 对于前列腺（体积）≤30g的BPH相关的LUTS患者，TUIP应作为手术治疗的一种选择。（中等推荐;证据级别：B级）

Transurethral vaporization of the prostate(TUVP)

经尿道前列腺汽化电切术（TUVP）

12. Bipolar TUVP may be offered to patients for the treatment of LUTS attributed to BPH. (Conditional Recommendation; Evidence Level: Grade B)

12.双极等离子汽化电切术可用于治疗BPH相关的LUTS。（有条件推荐;证据级别：B级）

Photoselective vaporization of the prostate(PVP)

经尿道选择性绿激光前列腺汽化术（PVP）

13. Clinicians should consider PVP as an option using 120W or 180W platforms for patients for the treatment of LUTS attributed to BPH. (Moderate Recommendation; Evidence Level: Grade B)

13.临床医生可考虑使用120W或180W能量平台PVP治疗BPH相关的LUTS患者。（中等推荐;证据级别：B级）

Prostatic urethral lift (PUL)

前列腺段尿道悬吊术（PUL）

14. Clinicians should consider PUL as an option for patients with LUTS attributed to BPH provided prostate volume <80g and verified absence of an obstructive middle lobe; however, patients should be informed that symptom reduction and flow rate improvement is less significant compared to TURP. Patients should be informed that evidence of efficacy and retreatment rates are poorly defined. (Moderate Recommendation; Evidence Level: Grade C)

14.对于前列腺体积<80g，且非中叶阻塞型BPH相关的LUTS患者，临床医生可考虑行前列腺段尿道悬吊术（PUL）；但应告知患者（该术式术后）症状缓解与尿流率改善效果不及TURP。（医生）应告知患者（该术式）有效性和再次治疗率暂未明确。（中等推荐;证据级别：C级）

15. PUL may be offered to eligible patients concerned with erectile and ejaculatory function for the treatment of with LUTS attributed to BPH. (Conditional Recommendation; Evidence Level: Grade C)

15.治疗BPH相关的LUTS，前列腺段尿道悬吊术（PUL）可用于对勃起和射精功能需求且符合条件的患者。（有条件推荐;证据级别：C级）

Transurethral microwave therapy (TUMT)

经尿道微波热疗（TUMT）

16. TUMT may be offered to patients with LUTS attributed to BPH; however, patients should be informed that surgical retreatment rates are higher compared to TURP. (Conditional Recommendation; Evidence Level: Grade C)

16.经尿道微波热疗（TUMT）可用于治疗BPH相关的LUTS患者；但应告知患者再次手术率高于TURP。（有条件推荐;证据级别：C级）

Water vapor thermal therapy

水蒸气（消融）热疗法

17. Water vapor thermal therapy may be offered to patients with LUTS attributed to BPH provided prostate volume <80g; however, patients should be counseled regarding efficacy and retreatment rates. (Conditional Recommendation; Evidence Level: Grade C)

17.对前列腺体积<80g BPH相关的LUTS患者，可采用（前列腺）水蒸气消融疗法；然而，（该术式的）疗效和复发率方面应告知患者。（有条件推荐;证据级别：C级）

18. Water vapor thermal therapy may be offered to eligible patients who desire preservation of erectile and ejaculatory function. (Conditional Recommendation; Evidence Level: Grade C)

18. 水蒸气消融疗法可用于希望保留勃起和射精功能的患者。（有条件推荐;证据级别：C级）

Transurethral needle ablation (TUNA)

经尿道针刺消融术（TUNA）

19. TUNA is not recommended for the treatment of LUTS attributed to BPH. (Expert Opinion)

19.不建议将经尿道针刺消融术（TUNA）用于治疗由BPH引起的LUTS。（专家意见）

Laser enucleantion 

激光剜除术

20. Clinicians should consider holmium laser enucleation of the prostate (HoLEP) or thulium laser enucleation of the prostate (ThuLEP), depending on their expertise with either technique, as prostate size-independent suitable options for the treatment of LUTS attributed to BPH. (Moderate Recommendation; Evidence Level: Grade B)

20.临床医生应考虑采用钬激光前列腺剜除术（HoLEP）或铥激光前列腺剜除术（ThuLEP），HoLEP及ThuLEP对前列腺体积没有要求，术者应根据自己的专长选择合适的术式治疗BPH相关LUTS。（中等推荐;证据级别：B级）

Aquablation

  前列腺水刀

21. Aquablation may be offered to patients with LUTS attributed to BPH provided prostate volume >30/<80g, however, patients should be informed that long term evidence of efficacy and retreatment rates, remains limited. (Conditional Recommendation; Evidence Level: Grade C)

21.前列腺水刀（Aquablation）可用于治疗前列腺体积体积介于 30-80g BPH相关的LUTS患者，但应告知有效性和复发率的长期证据仍然有限。（有条件的建议;证据级别：C级）

Prostate artery embolization (PAE)

前列腺动脉栓塞术（PAE）

22. PAE is not recommended for the treatment of LUTS attributed to BPH outside the context of a clinical trial. (Expert Opinion)

22.在临床试验范围之外，不推荐PAE用于治疗BPH相关的LUTS。（专家意见）

Medically complicated patients

医学上复杂的患者

23. HoLEP, PVP, and ThuLEP should be considered in patients who are at higher risk of bleeding, such as those on anti-coagulation drugs. (Expert Opinion)

23.对于使用抗凝血药物等出血风险较高的患者，应考虑使用HoLEP，PVP和ThuLEP。（专家意见）

*翻译仅供学习交流，不作为临床实践标准

编译：徐煜宇(广州医科大学附属第五医院)

编辑：榭小仙

审核：罗晓辉 李军