前尿道狭窄手术前后射精功能状况及影响因素研究
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摘要
目的:研究男性前尿道狭窄患者尿道成形术前后的射精功能(EjF)状况,并分析相关影响因素。方法:采用男性性健康问卷射精功能障碍部分(MSHQ-EjD)对41例成功接受开放性尿道成形术治疗的男性前尿道狭窄患者手术前后的EjF状况进行调查分析。结果:41例患者中,射精功能障碍(EjD)者由术前的20例(48.78%)减少至术后的15例(36.59%);患者总体EjF评分在术后显著提高(P=0.0466),症状困扰评分在手术前后的差异无统计学意义(P=0.1162)。术前EjD患者的EjF评分在术后显著提高(P=0.0003),症状困扰评分显著下降(P=0.0220),EjF正常患者的EjF评分和症状困扰评分均未在术后出现明显的变化(P=0.0640,0.7708)。年龄<40岁患者的EjF评分在术后显著提高(P=0.0279),而≥40岁患者的EjF评分提高不明显(P=0.6033),两组患者的症状困扰评分在手术前后均无明显差异(P=0.1467,0.4973)。球部尿道狭窄患者中的11例(91.67%)接受尿道端端吻合术,术后EjF评分显著提高(P=0.0117),但症状困扰评分下降不明显(P=0.0703);阴茎部尿道狭窄患者中的10例(34.48%)接受带蒂皮瓣尿道成形术,19例(65.52%)接受游离移植物尿道成形术,术后EjF评分和症状困扰评分均未出现明显的变化(P=0.6912,0.7093)。结论:男性前尿道狭窄患者存在一定的射精问题,前尿道成形术可以改善患者的EjF,但只见于术前存在EjD、年龄较小或球部尿道狭窄的患者。
Objective:To evaluate the male ejaculatory function(EjF)before and after anterior urethroplasty, and analyze its influencing factors.Method:A total of 41 male patients who benefitted from anterior urethroplasty were enrolled in this study,and the Male Sexual Health Questionnaire Ejaculatory Dysfunction(MSHQ-EjD)was used for subjectively assessing their EjF before and after urethroplasty respectively.Result:The number of patients with ejaculatory dysfunction(EjD)declined from 20(48.78%)to 15(36.59%)after urethroplasty.Of all the 41 patients,EjF score increased significantly after surgery(P= 0.0466),while bother score did not change postoperatively(P=0.1162).Both EjF score and bother score changed significantly after surgery in patients with EjD(P=0.0003,0.0220),but not in patients with normal EjF(P=0.0640,0.7708).Pre-and postoperative EjF scores differed significantly in patients with age< 40years old(P= 0.0279),but pre-and postoperative bother scores did not(P= 0.1467).Neither EjF score nor bother score of patients with age ≥ 40years old changed postoperatively(P=0.6033,0.4973).EjF score increased significantly postoperatively(P=0.0117)in patients with bulbar urethral stricture of whom 11(91.67%)accepted end-to-end anastomotic urethroplasty,but it did not change postoperatively(P=0.6912)in patients with penile urethral stricture of whom 10(34.48%)accepted skin flap urethroplasty and 19(65.52%)accepted graft urethroplasty.Moreover,bother score did not change postoperatively in patients with bulbar or penile urethral stricture(P=0.0703,0.7093).Conclusion:Male patients with anterior urethral stricture suffer from ejaculatory problem to some extent.Anterior urethroplasty can improve EjF only in patients with EjD,younger age,or bulbar urethral stricture.
Objective:To evaluate the male ejaculatory function(EjF)before and after anterior urethroplasty, and analyze its influencing factors.Method:A total of 41 male patients who benefitted from anterior urethroplasty were enrolled in this study,and the Male Sexual Health Questionnaire Ejaculatory Dysfunction(MSHQ-EjD)was used for subjectively assessing their EjF before and after urethroplasty respectively.Result:The number of patients with ejaculatory dysfunction(EjD)declined from 20(48.78%)to 15(36.59%)after urethroplasty.Of all the 41 patients,EjF score increased significantly after surgery(P= 0.0466),while bother score did not change postoperatively(P=0.1162).Both EjF score and bother score changed significantly after surgery in patients with EjD(P=0.0003,0.0220),but not in patients with normal EjF(P=0.0640,0.7708).Pre-and postoperative EjF scores differed significantly in patients with age< 40years old(P= 0.0279),but pre-and postoperative bother scores did not(P= 0.1467).Neither EjF score nor bother score of patients with age ≥ 40years old changed postoperatively(P=0.6033,0.4973).EjF score increased significantly postoperatively(P=0.0117)in patients with bulbar urethral stricture of whom 11(91.67%)accepted end-to-end anastomotic urethroplasty,but it did not change postoperatively(P=0.6912)in patients with penile urethral stricture of whom 10(34.48%)accepted skin flap urethroplasty and 19(65.52%)accepted graft urethroplasty.Moreover,bother score did not change postoperatively in patients with bulbar or penile urethral stricture(P=0.0703,0.7093).Conclusion:Male patients with anterior urethral stricture suffer from ejaculatory problem to some extent.Anterior urethroplasty can improve EjF only in patients with EjD,younger age,or bulbar urethral stricture.
引文
1 Coursey J W,Morey A F,McAninch J W,et al.Erectile function after anterior urethroplasty[J].J Urol,2001,166(6):2273-2276.
2 Dogra P N,Saini A K,Seth A.Erectile dysfunction after anterior urethroplasty:aprospective analysis of incidence and probability of recovery--single-center experience[J].Urology,2011,78(1):78-81.
3 Rosen R C,Catania J,Pollack L,et al.Male Sexual Health Questionnaire(MSHQ):scale development and psychometric validation[J].Urology,2004,64(4):777-782.
4 Rosen R C,Catania J A,Althof S E,et al.Development and validation of four-item version of Male Sexual Health Questionnaire to assess ejaculatory dysfunction[J].Urology,2007,69(5):805-809.
5 Erickson B A,Wysock J S,McVary K T,et al.Erectile function,sexual drive,and ejaculatory function after reconstructive surgery for anterior urethral stricture disease[J].BJU Int,2007,99(3):607-611.
6 Yang C C,Bradley W E.Somatic innervation of the human bulbocavernosus muscle[J].Clin Neurophysiol,1999,110(3):412-418.
7 Yang C C,Bradley W E.Reflex innervation of the bulbocavernosus muscle[J].BJU Int,2000,85(7):857-863.
8 Vijayan P,Sundin T.Island patch urethroplasty:effects on urinary flow and ejaculation[J].Br J Urol,1983,55(1):69-72.
9 Barbagli G,De Angelis M,Romano G,et al.Longterm followup of bulbar end-to-end anastomosis:a retrospective analysis of 153patients in a single center experience[J].J Urol,2007,178(6):2470-2473.
10 Wieder J A,Brackett N L,Lynne C M,et al.Anesthetic block of the dorsal penile nerve inhibits vibratory-induced ejaculation in men with spinal cord injuries[J].Urology,2000,55(6):915-917.
11 Erickson B A,Granieri M A,Meeks J J,et al.Prospective analysis of ejaculatory function after anterior urethral reconstruction[J].J Urol,2010,184(1):238-242.
2 Dogra P N,Saini A K,Seth A.Erectile dysfunction after anterior urethroplasty:aprospective analysis of incidence and probability of recovery--single-center experience[J].Urology,2011,78(1):78-81.
3 Rosen R C,Catania J,Pollack L,et al.Male Sexual Health Questionnaire(MSHQ):scale development and psychometric validation[J].Urology,2004,64(4):777-782.
4 Rosen R C,Catania J A,Althof S E,et al.Development and validation of four-item version of Male Sexual Health Questionnaire to assess ejaculatory dysfunction[J].Urology,2007,69(5):805-809.
5 Erickson B A,Wysock J S,McVary K T,et al.Erectile function,sexual drive,and ejaculatory function after reconstructive surgery for anterior urethral stricture disease[J].BJU Int,2007,99(3):607-611.
6 Yang C C,Bradley W E.Somatic innervation of the human bulbocavernosus muscle[J].Clin Neurophysiol,1999,110(3):412-418.
7 Yang C C,Bradley W E.Reflex innervation of the bulbocavernosus muscle[J].BJU Int,2000,85(7):857-863.
8 Vijayan P,Sundin T.Island patch urethroplasty:effects on urinary flow and ejaculation[J].Br J Urol,1983,55(1):69-72.
9 Barbagli G,De Angelis M,Romano G,et al.Longterm followup of bulbar end-to-end anastomosis:a retrospective analysis of 153patients in a single center experience[J].J Urol,2007,178(6):2470-2473.
10 Wieder J A,Brackett N L,Lynne C M,et al.Anesthetic block of the dorsal penile nerve inhibits vibratory-induced ejaculation in men with spinal cord injuries[J].Urology,2000,55(6):915-917.
11 Erickson B A,Granieri M A,Meeks J J,et al.Prospective analysis of ejaculatory function after anterior urethral reconstruction[J].J Urol,2010,184(1):238-242.