尿道重建治疗男性尿道狭窄对勃起功能、性生活质量的影响
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摘要
目的:探讨男性尿道狭窄行尿道重建手术对勃起功能以及性生活质量的影响因素。
方法:2003年1月~ 2007年1月间在我科接受尿道重建手术的男性尿道狭窄患者共517例,根据研究需要筛选出326例20岁~ 65岁男性患者,回顾性分析这326例接受尿道重建手术的男性患者的临床资料,并进行随访,分析年龄、尿道狭窄部位、长度、手术方式、手术次数、尿道狭窄复发对术后勃起功能及性生活质量的影响。
结果:共收集到172份(52.8%)有效数据,平均随访时间28.5月。患者年龄41.8±12.0岁,狭窄长度0.5 ~ 20(3.7±3.9)cm,手术采用尿道内切开术56例、经会阴途径尿道吻合57例、经耻骨途径尿道吻合7例、各种自体组织替代尿道重建术52例。手术次数1 ~ 9(1.9±1.4)次。总体而言,术后生活质量QoL评分、最大尿流率Qmax均有明显改善,P<0.05;手术后勃起功能(P=0.002)、性生活质量评分(P=0.026)较术前明显下降。按照年龄分组,<40岁、40 ~ 50岁患者IIEF-5评分比术前下降明显;按照狭窄长度分组,2 ~ 5cm组患者术后IIEF-5评分下降明显;按照狭窄部位分组,后尿道狭窄患者术后IIEF-5评分下降明显;按照术式分组,仅经会阴途径尿道端端吻合会降低患者术后勃起功能。而且术后尿道狭窄复发能明显影响到患者勃起功能,P<0.05。术前56例(32.6%)ED患者,术后随访时88例患者出现ED(51.2%),增加18.6%,术前勃起功能正常116例患者中有38例(32.8%)患者术后出现ED,术前56例ED患者中有6例(10.7%)患者术后勃起功能明显改善。比较术后3个月与术后6个月SLQQ评分,分别为40.8±33.9、49.6±33.1,P<0.05,IIEF-5评分分别为14.5±10.9、16.0±10.2, P<0.05,两者均有统计学意义。
结论:尿道重建治疗男性尿道狭窄手术会降低患者术后勃起功能及性生活质量。尿道狭窄部位、手术方式、术后尿道狭窄复发是降低术后患者勃起功能、性生活质量的主要因素。后尿道狭窄、采用经会阴途径尿道吻合患者术后勃起功能障碍发生率更大。勃起功能、性生活质量随着时间增长而逐渐改善。
Objective: To evaluate the effects of urethral reconstructive surgery on erectile function and sexual life quality.
Methods: There were 517 patients who were underwent urethroplasty for urethral stricture disease in our department from January 2003 to January 2007. We got 326 patients according to our research demand and analyzed retrospectively their clinical data. The 326 male patients were followed up in order to evaluate the effects of urethral reconstructive surgery on erectile function and sexual life quality.
Results: 172 valid data points were collected. The mean follow-up time was 28.5 months. The mean age and stricture length was 41.8±12.0 years, 0.5 ~ 20(3.7±3.9)cm. We used 4 different surgery methods which were internal urethrotomy (56 pts), posterior anastomotic urethroplasty through perinaeum (57 pts), posterior anastomotic urethroplasty through symphysis pubis (7 pts), substitution urethroplasty with autologous tisse (52 pts). The quality of life and maximum uroflomentry were improved obviously than pre-surgery (P < 0.05). The mean IIEF-5 scores (P=0.002) and sexual life quality scores (P=0.026) were statistically significantly reduced after surgery. We divided the patients into groups. The IIEF-5 scores were decreased than pre-surgery in four groups which were the patients less than 50 years old, the patients with 2-5cm-length stricture, the patients with posterior urethra stricture, and the patients underwent posterior anastomotic urethroplasty through perinaeum. And the recurrence of urethral stricture influenced the erectile function too, P<0.05. There were 56(32.6%) patients with erectile dysfunction before surgery and 88(51.2%) patients after surgery. 38 patients (32.8%) of the 116 normal patients reported ED after surgery. 6 patients (10.7%) of the 56 patients with ED reported normal after surgery. The SLQQ scores of 3 months and 6 months after surgery were 40.8±33.9、49.6±33.1,P<0.05,The IIEF-5 scores of 3 months and 6 months after surgery were 14.5±10.9、16.0±10.2,P<0.05.
Conclusion: Reconstructive surgery for urethral stricture disease will degrade the patients’erectile function and sexual life quality. All of the location of urethral stricture, surgery method, and post-surgical urethral stricture recurrence influence erectile function and sexual life quality after urethral reconstructive surgery. The two factors which are posterior urethra stricture and posterior anastomotic urethroplasty through perinaeum improve post-surgery erectile function rate more possibly. Erectile function and sexual life quality improve gradually with time growing.
方法:2003年1月~ 2007年1月间在我科接受尿道重建手术的男性尿道狭窄患者共517例,根据研究需要筛选出326例20岁~ 65岁男性患者,回顾性分析这326例接受尿道重建手术的男性患者的临床资料,并进行随访,分析年龄、尿道狭窄部位、长度、手术方式、手术次数、尿道狭窄复发对术后勃起功能及性生活质量的影响。
结果:共收集到172份(52.8%)有效数据,平均随访时间28.5月。患者年龄41.8±12.0岁,狭窄长度0.5 ~ 20(3.7±3.9)cm,手术采用尿道内切开术56例、经会阴途径尿道吻合57例、经耻骨途径尿道吻合7例、各种自体组织替代尿道重建术52例。手术次数1 ~ 9(1.9±1.4)次。总体而言,术后生活质量QoL评分、最大尿流率Qmax均有明显改善,P<0.05;手术后勃起功能(P=0.002)、性生活质量评分(P=0.026)较术前明显下降。按照年龄分组,<40岁、40 ~ 50岁患者IIEF-5评分比术前下降明显;按照狭窄长度分组,2 ~ 5cm组患者术后IIEF-5评分下降明显;按照狭窄部位分组,后尿道狭窄患者术后IIEF-5评分下降明显;按照术式分组,仅经会阴途径尿道端端吻合会降低患者术后勃起功能。而且术后尿道狭窄复发能明显影响到患者勃起功能,P<0.05。术前56例(32.6%)ED患者,术后随访时88例患者出现ED(51.2%),增加18.6%,术前勃起功能正常116例患者中有38例(32.8%)患者术后出现ED,术前56例ED患者中有6例(10.7%)患者术后勃起功能明显改善。比较术后3个月与术后6个月SLQQ评分,分别为40.8±33.9、49.6±33.1,P<0.05,IIEF-5评分分别为14.5±10.9、16.0±10.2, P<0.05,两者均有统计学意义。
结论:尿道重建治疗男性尿道狭窄手术会降低患者术后勃起功能及性生活质量。尿道狭窄部位、手术方式、术后尿道狭窄复发是降低术后患者勃起功能、性生活质量的主要因素。后尿道狭窄、采用经会阴途径尿道吻合患者术后勃起功能障碍发生率更大。勃起功能、性生活质量随着时间增长而逐渐改善。
Objective: To evaluate the effects of urethral reconstructive surgery on erectile function and sexual life quality.
Methods: There were 517 patients who were underwent urethroplasty for urethral stricture disease in our department from January 2003 to January 2007. We got 326 patients according to our research demand and analyzed retrospectively their clinical data. The 326 male patients were followed up in order to evaluate the effects of urethral reconstructive surgery on erectile function and sexual life quality.
Results: 172 valid data points were collected. The mean follow-up time was 28.5 months. The mean age and stricture length was 41.8±12.0 years, 0.5 ~ 20(3.7±3.9)cm. We used 4 different surgery methods which were internal urethrotomy (56 pts), posterior anastomotic urethroplasty through perinaeum (57 pts), posterior anastomotic urethroplasty through symphysis pubis (7 pts), substitution urethroplasty with autologous tisse (52 pts). The quality of life and maximum uroflomentry were improved obviously than pre-surgery (P < 0.05). The mean IIEF-5 scores (P=0.002) and sexual life quality scores (P=0.026) were statistically significantly reduced after surgery. We divided the patients into groups. The IIEF-5 scores were decreased than pre-surgery in four groups which were the patients less than 50 years old, the patients with 2-5cm-length stricture, the patients with posterior urethra stricture, and the patients underwent posterior anastomotic urethroplasty through perinaeum. And the recurrence of urethral stricture influenced the erectile function too, P<0.05. There were 56(32.6%) patients with erectile dysfunction before surgery and 88(51.2%) patients after surgery. 38 patients (32.8%) of the 116 normal patients reported ED after surgery. 6 patients (10.7%) of the 56 patients with ED reported normal after surgery. The SLQQ scores of 3 months and 6 months after surgery were 40.8±33.9、49.6±33.1,P<0.05,The IIEF-5 scores of 3 months and 6 months after surgery were 14.5±10.9、16.0±10.2,P<0.05.
Conclusion: Reconstructive surgery for urethral stricture disease will degrade the patients’erectile function and sexual life quality. All of the location of urethral stricture, surgery method, and post-surgical urethral stricture recurrence influence erectile function and sexual life quality after urethral reconstructive surgery. The two factors which are posterior urethra stricture and posterior anastomotic urethroplasty through perinaeum improve post-surgery erectile function rate more possibly. Erectile function and sexual life quality improve gradually with time growing.
引文
1 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
2 Woodward J M, Hass S L, Woodward P J. Reliability and validity of the sexual life quality questionnaire (SLQQ) [J]. Qual Life Res, 2002, 11(4):365-377
3 Xu Y M, Qiao Y, Sa Y L, et al. Substitution urethroplasty of complex and long-segment urethral strictures: a rationale for procedure selection[J]. Eur Urol, 2007, 51(4): 1093-1099
4 吴宏飞, 钱立新, 顾民, 等. 游离包皮瓣补片式尿道成形术治疗长段尿道狭窄[J]. 中华男科学杂志, 2003, 9(9): 661-662
5 徐月敏, 撒应龙, 吴登龙, 等. 舌黏膜尿道成形治疗尿道狭窄的初步报告[J]. 临床泌尿外科杂志, 2007,22(7):486-488
6 Harwood P J, Grotz M, Eardley I, et al. Erectile dysfunction after fracture of the pelvis[J]. J Bone Joint Surg Br, 2005, 87(3):281-290
7 Husmann DA, Wilson WT, Boone TB,etc. Prostatomembranous urethral disruptions: management by suprapubic cystostomy and delayed urethroplasty[J]. J Urol. 1990, 144: 76-78
8 Koraitim M M. On the art of anastomic posterior urethroplasty: a 27-year experience[J]. J Urol, 2005, 173: 135-139
9 Corsey J W, Morey A F, Mcaninch J W, et al. Erectile function after anterior urethroplasty[J]. J Urol, 2001, 166: 2273~2276
10 冯超, 徐月敏, 俞建军, 等. 尿道外伤患者勃起功能障碍相关因素的临床研究[J]. 中国男科学杂志, 2006,20(8):22-26
11 Moudouni S, Tazi K, Koutani A, et al. Comparative results of the treatment of post-traumatic ruptures of the membranous urethra with endoscopic realignment and surgery [J]. Prog Urol, 2001, 11(1): 56-61
12 Xu Y M, Qiao Y, Sa Y L, et al. 1-stage urethral reconstruction using colonic mucosal graft for the treatment of a long complex urthral stricture[J]. J Urol, 2004, 171(1): 220-223
13 Mundy A R. Results and complications of urethroplasty and its future[J]. Br J Urol, 1993, 71(3): 322-325
14 Corriere J N. 1-Stage delayed bulboprostatic anastomotic repair of posterior urethral rupture: 60 patients with 1-year followup[J]. J Urol, 2001, 165(2): 404-407
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1 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.
2 Woodward J M, Hass S L, Woodward P J. Reliability and validity of the sexual life quality questionnaire (SLQQ) [J]. Qual Life Res, 2002, 11(4):365-377.
3 Xu Y M, Qiao Y, Sa Y L, et al. Substitution urethroplasty of complex and long-segment urethral strictures: a rationale for procedure selection[J]. Eur Urol, 2007, 51(4): 1093-1099.
4 吴宏飞,钱立新,顾民,等.游离包皮瓣补片式尿道成形术治疗长段尿道狭窄[J].中华男科学杂志,2003,9(9):661-662.
5 徐月敏,撒应龙,吴登龙,等.舌黏膜尿道成形治疗尿道狭窄的初步报告[J]. 临床泌尿外科杂志, 2007,22(7):486-488.
6 冯超,徐月敏,俞建军,等.尿道外伤患者勃起功能障碍相关因素的临床研究[J].中国男科学杂志, 2006,20(8):22-26.
7 Moudouni S, Tazi K, Koutani A, et al. Comparative results of the treatment of post-traumatic ruptures of the membranous urethra with endoscopic realignment and surgery [J]. Prog Urol, 2001, 11(1): 56-61.
8 Harwood P J, Grotz M, Eardley I, et al. Erectile dysfunction after fracture of the pelvis [J]. J Bone Joint Surg Br, 2005, 87(3):281-290.
9 Xu Y M, Qiao Y, Sa Y L, et al. 1-stage urethral reconstruction using colonic mucosal graft for the treatment of a long complex urthral stricture [J]. J Urol, 2004, 171(1): 220-223.
10 Mundy A R. Results and complications of urethroplasty and its future [J].Br J Urol, 1993, 71(3): 322-325.
11 Corriere J N. 1-Stage delayed bulboprostatic anastomotic repair of posterior urethral rupture: 60 patients with 1-year followup [J]. J Urol, 2001, 165(2):404-407.
2 Woodward J M, Hass S L, Woodward P J. Reliability and validity of the sexual life quality questionnaire (SLQQ) [J]. Qual Life Res, 2002, 11(4):365-377
3 Xu Y M, Qiao Y, Sa Y L, et al. Substitution urethroplasty of complex and long-segment urethral strictures: a rationale for procedure selection[J]. Eur Urol, 2007, 51(4): 1093-1099
4 吴宏飞, 钱立新, 顾民, 等. 游离包皮瓣补片式尿道成形术治疗长段尿道狭窄[J]. 中华男科学杂志, 2003, 9(9): 661-662
5 徐月敏, 撒应龙, 吴登龙, 等. 舌黏膜尿道成形治疗尿道狭窄的初步报告[J]. 临床泌尿外科杂志, 2007,22(7):486-488
6 Harwood P J, Grotz M, Eardley I, et al. Erectile dysfunction after fracture of the pelvis[J]. J Bone Joint Surg Br, 2005, 87(3):281-290
7 Husmann DA, Wilson WT, Boone TB,etc. Prostatomembranous urethral disruptions: management by suprapubic cystostomy and delayed urethroplasty[J]. J Urol. 1990, 144: 76-78
8 Koraitim M M. On the art of anastomic posterior urethroplasty: a 27-year experience[J]. J Urol, 2005, 173: 135-139
9 Corsey J W, Morey A F, Mcaninch J W, et al. Erectile function after anterior urethroplasty[J]. J Urol, 2001, 166: 2273~2276
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