经尿道等离子切除前列腺的膀胱功能及性功能的影响

Effects of ttransurethral enucleationa resection of prostate on bladder function and sexual function of patients with large-volume benign prostatic hyperplasia

目的:分析经尿道前列腺等离子剜除术(TUERP)与经尿道前列腺电切术(TURP)治疗大体积前列腺增生(BPH)患者的疗效及对膀胱功能和性功能的影响。方法:121例大体积BPH按手术方式分为TUERP组(65例)与TURP组(56例),比较两组手术情况(手术时间、术中出血量、膀胱冲洗时间、前列腺切除质量、留置尿管时间、住院时间);统计术后并发症发生率;测定术前、术后6个月最大尿流率(Qmax)、剩余尿量(PVR)、国际尿失禁问卷简表(ICIQ-SF)、国际前列腺症状评分(IPSS)、勃起功能问卷-5评分(IIEF-5)的变化,分析不同术式对大体积BPH患者膀胱功能、尿失禁、性功能的影响。结果:TUERP组手术时间、膀胱冲洗时间、留置尿管时间、住院时间短于TURP组,术中出血量较TURP组少,前列腺切除质量大于TURP组(P<0.05),手术总并发症发生率低于TURP组(P<0.05);术后6个月,两组Qmax均上升,PVR均降低(P<0.05),TUERP组Qmax高于TURP组,PVR低于TURP组(P<0.05);术后6个月,两组IPSS、IIEF-5均降低,ICIQ-SF评分上升(P<0.05),TUERP组IIEF-5评分低于TURP组(P<0.05);术后6个月,TURP组勃起功能障碍发生率和逆行射精率升高(P<0.05),TUERP组勃起功能障碍、逆行射精率均低于TURP组(P<0.05)。结论:TUERP术治疗大体积增生的前列腺整体价值优于TURP,微创、出血少、并发症少,对性功能影响小,尿失禁发生率低,膀胱功能恢复好。

Objective:To analyze the efficacy of transurethral enucleationa resection of prostate(TUERP)vs.transurethral resection of prostate(TURP)for large-volume benign prostatic hyperplasia(BPH)and their influence on bladder function and sexual functions.Methods:121 cases of large-volume BPH were divided into TUERP group(n=65)and TURP group(n=56)according to the operation methods.The surgical conditions(operative time,intraoperative blood loss,bladder irrigation time,the weight of prostate resected,indwelling urinary catheter time,hospital stay)were compared between the two groups,and the incidence of surgical complications was counted.The maximum urinary flow rate(Qmax),post-voiding residual(PVR),International Consultation on Incontinence Questionnaire-Short Form(ICIQ-SF),International Prostate Symptom Score(IPSS)and International Index of Erectile Function-5 score(IIEF-5)were measured before and 6 months after surgery.The effects of different surgical procedures on bladder function,urinary incontinence and sexual function of patients with large-volume BPH were analyzed.Results:The operative time,bladder irrigation time,indwelling urinary catheter time and hospital stay were significantly shorter,the intraoperative blood loss was significantly less,the weight of prostate resected was significantly heavier,and the incidence of total surgical complications was significantly lower in TUERP group than those in TURP group(all P<0.05).At 6th month after surgery,Qmax in the two groups was increased while PVR was decreased(P<0.05),and Qmax was significantly higher while PVR was significantly lower in TUERP group than those in TURP group(all P<0.05).At 6th month after surgery,the scores of IPSS and IIEF-5 in the two groups were decreased while the ICIQ-SF score was increased(P<0.05),and the IIEF-5 score in TUERP group was significantly lower than that in TURP group(P<0.05).At 6th month after surgery,the erectile dysfunction and retrograde ejaculation rate were increased in TURP group(P<0.05),and the erectile dysfunction and retrograde ejaculation rate in TUERP group were significantly lower than those in TURP group(P<0.05).Conclusion:The overall values of TUERP in the treatment of large-volume BPH is better than TURP,and TUERP has minimally invasion,little bleeding,few complications,small impact on sexual function,low incidence of urinary incontinence and good recovery of bladder function.