保留膀胱颈的前列腺剜除术对性功能的影响及处理

The impact of plasmakinetic enucleation of prostate with bladder neck reservation on sexual function and treatment

目的:评价保留膀胱颈的前列腺剜除术(PKEP)对良性前列腺增生(BPH)患者性功能的影响及口服西地那非的治疗效果。方法:将符合条件的160例患者随机分成常规方法经尿道等离子体前列腺汽化电切术(PKRP)组(70例)及PKEP组(90例),随访两组患者术后6、12个月性欲、勃起功能与射精情况。对于术后发生勃起功能障碍(ED)的患者给予长期小剂量(25mg,6周)口服西地那非治疗,观察疗效。结果:两组患者随访至术后12个月,阴茎ED的发生率分别为PKRP组7.14%(5/70)、PKEP组7.78%(7/90)(P>0.05),逆行射精(RE)的发生率分别为PKRP组52.86%(37/70)、PKEP组25.56%(23/90)(P<0.05)。术后ED患者长期小剂量口服西地那非治疗后,无明显副作用,勃起功能改善率为83.33%(10/12)。结论:PKRP与PKEP手术对性功能均有一定的影响,两组ED发生率无明显差异,但RE发生率PKEP明显少于PKRP。对于术后发生ED的患者,长期小剂量口服西地那非,效果良好。

Objective:To evaluate the impact of transurethral plasmakinetic enucleation of the prostate(PKEP) and sildenafil treatment on sexual functions of the patients with benign prostatic hyperplasia(BPH).Methods:One hundred and sixty patients with BPH were divided into two groups randomly:plasmakinetic resection of the prostate(PKRP)group with 70cases and PKEP group with 90cases.Their libido,erectile function and ejaculation in the 6th and 12th month after operation were observed.For erectile dysfunction(ED)patients,therapeutic effect of long period and low dose sildenafil(25mg,6weeks)were evaluated.Results:The IIEF-5of both groups decreased in the 6th and 12th month after operation,and no significant difference was found between them.In the 12th month,the incidence rate of ED and the incidence rate of RE of PKRP group and PKEP group were 7.14%(5/70),7.78%(7/90)(P>0.05)and 52.86%(37/70),25.56%(23/90)(P<0.05)respectively.The incidence rate of RE of PKEP group was lower than PKRP group.For 12ED patients after long period and low dose sildenafil,no obvious side effects,10(83.3%)had improved erections.Conclusions:Both PKRP and PKEP had influence on sexual function.There is no difference the incidence rate of ED between the two groups,but the incidence rate of RE of PKEP group was lower than PKRP group.For those ED patients,long period and low dose sildenafil may be an effective and safe way.