上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2020, Vol. 40 ›› Issue (4): 554-.doi: 10.3969/j.issn.1674-8115.2020.04.024

• 短篇论著 • 上一篇    

改良钬激光前列腺剜除术治疗良性前列腺增生对性功能的影响

顾本宏，钱海宁，孟 凯，杨登科，程曙杰，李 东   

  1. 上海交通大学医学院附属同仁医院泌尿外科，上海 200336
  • 出版日期:2020-04-28 发布日期:2020-05-22
  • 通讯作者: 李 东，电子信箱：ld3649@shtrhospital.com。
  • 作者简介:顾本宏（1975—）男，主治医师，硕士；电子信箱：gbh3834@shtrhospital.com。
  • 基金资助:
    上海市长宁区科学技术委员会一般项目（CNKW2018Y05，CNKW2018Y03）；上海市第六人民医院集团课题（ly201801）。

Effect of modified holmium laser enucleation of the prostate on sexual function in the treatment of benign prostatic hyperplasia

GU Ben-hong, QIAN Hai-ning, MENG Kai, YANG Deng-ke, CHENG Shu-jie, LI Dong   

  1. Department of Urology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
  • Online:2020-04-28 Published:2020-05-22
  • Supported by:
    General Project of Science and Technology Committee of Changning District of Shanghai Municipality (CNKW2018Y05, CNKW2018Y03); Shanghai Sixth Peoples Hospital Group Project (ly201801).

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摘要： 目的·研究改良钬激光前列腺剜除术（holmium laser enucleation of the prostate，HoLEP）治疗良性前列腺增生（benign prostatic hyperplasia，BPH）对患者性功能影响。方法·回顾性分析2017年2月—2018年10月采用改良HoLEP治疗的167例中老年BPH患者的临床资料。根据患者术后有、无性活动，将其分为研究组（65例）和对照组（102例），分析该2组患者术后性活动的风险因素。运用国际勃起功能指数 -5（international index of erectile function 5，IIEF-5）评分、勃起硬度评分（erection hardness score，EHS）模型和射精功能调查问卷记录并分析研究组患者术前及术后勃起、射精功能的变化。结果·2组患者在压力性尿失禁、术后住院时间、剜除前列腺组织质量、粉碎时间、总前列腺特异性抗原、术前尿潴留、剜除时间之间的差异均无统计学意义；研究组患者较对照组年轻，且差异具有统计学意义（P0.000）。研究组患者在术前及术后1、3、6个月的IIEF-5评分、EHS间差异均无统计学意义。该组患者在手术前后的射精潜伏期缩短、射精痛及有无精液射出间差异亦均无统计学意义，但射精量减少者由术前41.82%（23/55）大幅增加至术后92.73%（51/55）且差异具有统计学意义（P0.000）。结论·年龄是BPH患者术后性活动的风险因素。改良HoLEP对患者术后勃起功能无明显影响，对射精功能的影响表现为射出精液量减少。

关键词: 钬激光前列腺剜除术, 良性前列腺增生, 勃起功能, 射精功能

Abstract:

Objective · To study the effect of modified holmium laser enucleation of the prostate (HoLEP) on sexual function in patients with benign prostatic hyperplasia (BPH). Methods · The clinical data of 167 middle-aged and elderly patients with BPH treatedmodified HoLEP Feb. 2017 to Oct. 2018 were retrospectively analyzed. According to the status of sexual activity after operation, the patients were divided into study group who had sex (65 cases) and control group who had no sex (102 cases). The risk factors of sexual activity after operation in the two groups were analyzed. The changes of erectile function and ejaculatory function in the study group before and after operation were recorded and analyzedinternational index of erectile function (IIEF-5) score, erection hardness score (EHS) model and ejaculatory function questionnaire. Results · There were no significant differences between the two groups in the stress urinary incontinence, postoperative hospitalization time, weight of enucleated prostate, crush time, total prostate specific antigen, preoperative urinary retention and enucleation time. The patients in the study group were younger than those in the control group (P0.000). There were no significant differences in IIEF-5 score and EHS in the study group before and 1, 3, 6 months after operation. There were no significant differences in shorten ejaculation latency, ejaculation pain and ejaculation with or without semen in the study group before and after operation, but the patients of decreased semen volume increased 41.82% (23/55) to 92.73% (51/55) (P0.000). Conclusion · Age is a risk factor in BPH patients, whether there is sexual activity after modified HoLEP or not. The modified HoLEP has no significant effect on erectile function, but the effect on ejaculatory function is the decrease of ejaculated semen volume.

Key words: holmium laser enucleation of the prostate (HoLEP), benign prostatic hyperplasia (BPH), erectile function, ejaculation function