铥激光剥橘式前列腺切除术对良性前列腺增生患者性功能影响的临床研究
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摘要
目的:探讨铥激光剥橘式前列腺切除术对良性前列腺增生(BPH)患者性功能的影响。方法:选取我院120例采用铥激光剥橘式前列腺切除术进行治疗且尚有性生活的BPH患者为研究对象,随访并分析患者术前、术后6个月、12个月国际前列腺症状评分(IPSS)、生活质量评分(QOL)、残余尿量(PVR)、最大尿流率(Qmax)指标,使用国际勃起功能指数-5(IIEF-5)评价患者勃起情况,并记录患者射精疼痛、精量减少及逆行射精发生率。结果:术后6、12个月IPSS评分、QOL评分、PVR较术前均显著下降,Qmax较术前显著上升(P<0.05);术前和术后6、12个月的IIEF-5评分比较差异无统计学意义(P>0.05),勃起功能无明显下降。术后6、12个月精量减少、逆行射精发生率与术前比较差异有统计学意义(P<0.05);术后6、12个月射精疼痛发生率与术前比较差异无统计学意义(P>0.05)。结论:铥激光剥橘式前列腺切除术对患者性功能的影响较少。铥激光本身属性以及本术式独特的切除方法,对性功能具有一定的保护作用。
Objective:To evaluate the impact of thulium laser resection of the prostate-tangerine technique(TmLRP-TT)on sexual function of patients with benign prostatic hyperplasia(BPH).Method:BPH patients in our hospital from 2015 to 2016 were selected and treated with TmLRP-TT.IPSS,QOL,PVR,Qmax were recorded to evaluate the outcome of the operation,the sexual functions were evaluated with IIEF-5 before and after the operation and the incidence of painful ejaculation and retrograde ejaculation(RE)were counted.Result:Compared with the preoperative period,postoperative QOL,IPSS,PVR significantly decreased 6 and 12 months after surgery,while Qmaxsignificantly increased(P<0.05).No significant difference in erectile function before and after surgery were observed(P>0.05).The prevalence of postoperative RE increased and the ejaculatory volume reduced evidently after treatment(P<0.05),while difference in the incidence of painful ejaculation before and after surgery was not statistically significant(P>0.05).Conclusion:TmLRP-TT has little effect on the sexual function of BPH patients.The characteristic of thulium laser and the unique operation can provide protection for sexual function.
Objective:To evaluate the impact of thulium laser resection of the prostate-tangerine technique(TmLRP-TT)on sexual function of patients with benign prostatic hyperplasia(BPH).Method:BPH patients in our hospital from 2015 to 2016 were selected and treated with TmLRP-TT.IPSS,QOL,PVR,Qmax were recorded to evaluate the outcome of the operation,the sexual functions were evaluated with IIEF-5 before and after the operation and the incidence of painful ejaculation and retrograde ejaculation(RE)were counted.Result:Compared with the preoperative period,postoperative QOL,IPSS,PVR significantly decreased 6 and 12 months after surgery,while Qmaxsignificantly increased(P<0.05).No significant difference in erectile function before and after surgery were observed(P>0.05).The prevalence of postoperative RE increased and the ejaculatory volume reduced evidently after treatment(P<0.05),while difference in the incidence of painful ejaculation before and after surgery was not statistically significant(P>0.05).Conclusion:TmLRP-TT has little effect on the sexual function of BPH patients.The characteristic of thulium laser and the unique operation can provide protection for sexual function.
引文
1 夏术阶,张沂南,鲁军,等.铥激光"剥橘"式切除术治疗良性前列腺增生症[J].中华医学杂志,2005,85(45):3225-3228.
2 Xia S J.Two-micron(thulium)laser resection of the prostate-tangerine technique:a new method for BPHtreatment[J].Asian J Androl,2009,11(3):277-281.
3 van Rij S,Gilling P.Recent advances in treatment for Benign Prostatic Hyperplasia[J].F1000Res,2015.
4 Carmignani L,Bozzini G,Macchi A,et al.Sexual outcome of patients undergoing thulium laser enucleation of the prostate for benign prostatic hyperplasia[J].Asian J Androl,2015,17(5):802-806.
5 Oelke M,Bachmann A,Descazeaud A,et al.European Association of Urology.EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction[J].Eur Urol,2013,64(1):118-140.
6 邵晋凯,王毓斌,吕永安,等.120W2μm激光前列腺剜除术治疗良性前列腺增生[J].临床泌尿外科杂志,2011,26(8):603-605.
7 Xia S J,Zhuo J,Sun X W,et al.Thulium laser versus standard transurethral resection of the prostate:a randomized prospective trial[J].Eur Urol,2008,53(2):382-389.
8孙江江,杨龙,王宝龙,等.120W/2μm铥激光前列腺汽化剜除术治疗BPH的疗效观察[J].临床泌尿外科杂志,2013,28(4):273-275.
9 Nolan M W,Marolf A J,Ehrhart E J,et al.Pudendal nerve and internal pudendal artery damage may contribute to radiation-induced erectile dysfunction[J].Int JRadiat Oncol Biol Phys,2015,91(4):796-806.
10 Bach T,Huck N,Wezel F,et al.70vs 120 Wthulium:yttrium-aluminium-garnet 2 microm continuous-wave laser for the treatment of benign prostatic hyperplasia:a systematic ex-vivo evaluation[J].BJU Int,2010,106(3):368-372.
11 Spatafora S,Casarico A,Fandella A,et al.Evidencebased guidelines for the treatment of lower urinary tract symptoms related to uncomplicated benign prostatic hyperplasia in Italy:updated summary from AURO it[J].Ther Adv Urol,2012,4(6):279-301.
12 卓见,顾韧责,赵福军,等.2微米铥激光前列腺切除术对性功能的影响[J].微创泌尿外科杂志,2013,2(1):68-70.
13 Frieben R W,Lin H C,Hinh P P,et al.The impact of minimally invasive surgeries for the treatment of symptomatic benign prostatic hyperplasia on male sexual function:a systematic review[J].Asian J Androl,2010,12(4):500-508.
14 Choi H S,Kim D J,Kim D S,et al.Factors affecting the improvement of the initial peak urinary flow rate after transurethral resection of the prostate orphotoselective vaporization of the prostate for treating benign prostatic hyperplasia[J].Int Neurourol J,2011,15(1):35-40.
15 Ronzoni G,De Vecchis M.Preservation of anterograde ejaculation after transurethral resection of both the prostate and bladder neck[J].Br J Urol,2015,81(6):830-833.
2 Xia S J.Two-micron(thulium)laser resection of the prostate-tangerine technique:a new method for BPHtreatment[J].Asian J Androl,2009,11(3):277-281.
3 van Rij S,Gilling P.Recent advances in treatment for Benign Prostatic Hyperplasia[J].F1000Res,2015.
4 Carmignani L,Bozzini G,Macchi A,et al.Sexual outcome of patients undergoing thulium laser enucleation of the prostate for benign prostatic hyperplasia[J].Asian J Androl,2015,17(5):802-806.
5 Oelke M,Bachmann A,Descazeaud A,et al.European Association of Urology.EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction[J].Eur Urol,2013,64(1):118-140.
6 邵晋凯,王毓斌,吕永安,等.120W2μm激光前列腺剜除术治疗良性前列腺增生[J].临床泌尿外科杂志,2011,26(8):603-605.
7 Xia S J,Zhuo J,Sun X W,et al.Thulium laser versus standard transurethral resection of the prostate:a randomized prospective trial[J].Eur Urol,2008,53(2):382-389.
8孙江江,杨龙,王宝龙,等.120W/2μm铥激光前列腺汽化剜除术治疗BPH的疗效观察[J].临床泌尿外科杂志,2013,28(4):273-275.
9 Nolan M W,Marolf A J,Ehrhart E J,et al.Pudendal nerve and internal pudendal artery damage may contribute to radiation-induced erectile dysfunction[J].Int JRadiat Oncol Biol Phys,2015,91(4):796-806.
10 Bach T,Huck N,Wezel F,et al.70vs 120 Wthulium:yttrium-aluminium-garnet 2 microm continuous-wave laser for the treatment of benign prostatic hyperplasia:a systematic ex-vivo evaluation[J].BJU Int,2010,106(3):368-372.
11 Spatafora S,Casarico A,Fandella A,et al.Evidencebased guidelines for the treatment of lower urinary tract symptoms related to uncomplicated benign prostatic hyperplasia in Italy:updated summary from AURO it[J].Ther Adv Urol,2012,4(6):279-301.
12 卓见,顾韧责,赵福军,等.2微米铥激光前列腺切除术对性功能的影响[J].微创泌尿外科杂志,2013,2(1):68-70.
13 Frieben R W,Lin H C,Hinh P P,et al.The impact of minimally invasive surgeries for the treatment of symptomatic benign prostatic hyperplasia on male sexual function:a systematic review[J].Asian J Androl,2010,12(4):500-508.
14 Choi H S,Kim D J,Kim D S,et al.Factors affecting the improvement of the initial peak urinary flow rate after transurethral resection of the prostate orphotoselective vaporization of the prostate for treating benign prostatic hyperplasia[J].Int Neurourol J,2011,15(1):35-40.
15 Ronzoni G,De Vecchis M.Preservation of anterograde ejaculation after transurethral resection of both the prostate and bladder neck[J].Br J Urol,2015,81(6):830-833.