不同手术方式治疗前列腺增生症对患者性功能的影响

Sexual dysfunction following surgical treatment for benign prostatic hyperplasia

目的探讨不同手术方式治疗前列腺增生症对患者性功能的影响。方法以该院收治的370例接受不同手术方式的前列腺增生患者作为研究对象,其中160例行经尿道前列腺等离子电切术(等离子电切组),120例行经尿道前列腺激光切除术(激光切除组),90例经尿道前列腺激光剜除术(激光剜除组)。比较各组患者的临床信息、手术情况,术前术后勃起功能国际问卷评分(IIEF-5)、术前术后射精功能评分(CIPE),治疗前后前列腺症状评分[前列腺症状评分(IPSS)及生活质量评分(QOL)]、最大尿流率(Qmax)。结果激光切除组包膜穿孔、尿失禁的发生率最少,3组间两两比较差异均有统计学意义(P<0.05)。3组患者治疗前后IPSS、QOL分数、Qmax组间比较,差异无统计学意义(P>0.05),3组患者治疗前后IIEF-5、CIPE比较,差异均有统计学意义(P<0.05);3组间两两比较IIEF-5、CIPE得分、逆行射精发生率差异有统计学意义(P<0.05)。单因素分析中留置尿管时间、出血量、膀胱冲洗时间、包膜穿孔与术后性功能障碍的发生相关(P<0.05)。多元Logistic回归分析中,仅发现术中包膜穿孔与术后发生性功能障碍密切相关(P<0.05)。结论不同手术方式治疗前列腺增生均有确切效果,但对患者性功能均有一定影响,其中激光切除术对患者性功能影响较小,行激光剜除术患者性功能障碍发生率高于行其他手术方式患者。术中包膜穿孔是患者术后发生性功能障碍的高危因素。

Objective To explore the effect of different surgical methods on sexual function of benign prostatic hyperplasia(BPH)patients.Methods A total of 370 cases of BPH treated in the hospital were collected,including 160 cases of transurethral resection of prostate by plasma,120 cases of transurethral laser resection of prostate,and 90 cases of transurethral laser enucleation of prostate.The clinical information,operation status,international scale of erectile function before and after operation(IIEF-5),preoperative and postoperative ejaculatory function score(CIPE),prostate symptom score(IPSS and QOL)before and after treatment and maximum urinary flow rate(Qmax)of patients in each group were compared.Results The number of cases of capsule perforation and urinary incontinence was the least in laser resection group,and the differences were statistically significant(P<0.05).There was no significant difference on IPSS,QOL and Qmax before and after treatment among different groups(P>0.05).There were significant differences on IIEF-5 and ejaculation function between the three groups before and after treatment(P<0.05).There were significant differences in the incidence of IIEF-5,erectile function and retrograde ejaculation among the three groups(P<0.05).In univariate analysis,the time of indwelling catheter,haemorrhagia amount,bladder washing time and the perforation of capsule were related to the occurrence of sexual dysfunction(P<0.05).In multiple Logistic regression analysis,only the perforation of capsule during operation was closely related to sexual dysfunction(P<0.05).Conclusion The three surgical methods for BPH have definite effects on the treatment,but all of them have certain effects on sexual dysfunction of patients.Among them,laser resection has little effect on the sexual function and the incidence of sexual dysfunction of laser enucleation is higher than other surgical methods.The perforation of the capsule during the operation is a high risk factor of sexual dysfunction.