经尿道前列腺电切术与等离子电切术治疗大体积良性前列腺增生对患者勃起功能的影响比较

Effects of transurethral resection of the prostate versus plasmakinetic resection of the prostate on erectile function in patients with giant benign prostatic hyperplasia

目的比较大体积良性前列增生(BPH)患者接受经尿道前列腺电切术(TURP)与经尿道等离子电切术(PKRP)治疗的有效性及对患者勃起功能的影响。方法选取太原钢铁(集团)有限公司总医院2017年2月至2020年1月收治的大体积BPH患者100例,采用随机数字表法分为PKRP组与TURP组各50例,记录围术期指标,手术前后测量比较两组患者尿流动力学指标、血清指标,评估比较患者勃起功能及生活质量,统计术后勃起功能障碍、尿失禁、尿道狭窄等并发症发生情况。结果 PKRP组患者手术时长、住院时间、导尿管留置时长、术中失血量均短于、少于TURP组,差异均有统计学意义(t=14.35、8.74、6.20、8.34,均P < 0.001)。术前PKRP组与TURP组术前残余尿量、最大尿流率差异均无统计学意义(t=0.59、0.73,均P > 0.05),术后两组残余尿量均有下降,最大尿流率均有上升,且PKRP组残余尿量低于TURP组,最大尿流率高于经尿道前列腺电切术组,差异均有统计学意义(t=19.85、11.67,均P < 0.001)。术前两组血清前列腺特异性抗原及游离前列腺特异性抗原差异均无统计学意义(t=0.43、0.33,均P > 0.05),术后两组前列腺特异性抗原、游离前列腺特异性抗原水平均有下降,且PKRP组前列腺特异性抗原、游离前列腺特异性抗原水平低于TURP组(t=16.01、5.09,均P < 0.001)。术前两组生活质量指数评分及国际勃起功能指数评分差异均无统计学意义(t=0.62、0.63,均P > 0.05),术后国际勃起功能指数评分均有上升,生活质量指数评分均有下降,PKRP组国际勃起功能指数评分[(25.06±3.61)分]高于TURP组的(21.52±3.05)分;生活质量指数评分[(1.05±0.18)分]低于TURP组的(1.58±0.29)分,差异均有统计学意义(t=5.29、10.98,均P < 0.001)。术后PKRP组并发症发生率低于TURP组,差异有统计学意义(χ^(2)=5.98,P < 0.05)。结论该研究从勃起功能、生活质量、围术期指标等多方面观察两种临床常用术式在大体积BPH治疗的疗效差异,具有一定新颖性,结果证实大体积BPH患者接受PKRP手术与TURP手术均有改善患者勃起功能、血清指标、尿动力学指标的作用,不过PKRP手术创伤性更小,改善效果更佳,术后并发症更少,可优先选用。

Objective To investigate the efficacy of transurethral resection of the prostate(TURP)versus plasmakinetic resection of the prostate(PKRP)in the treatment of patients with giant benign prostatic hyperplasia and their effects on erectile function.Methods A total of 100 patients with GBPH who received treatment in the General Hospital of Taiyuan Iron and Steel(Group)Co.,Ltd.,from February 2017 to January 2020 were included in this study.They were randomly assigned to undergo either PKRP(PKRP group,n=50)or TURP(TURP group,n=50).Perioperative indicators were recorded.Urodynamic indicators and serum indicators pre-and post-operation were compared between the two groups.Erectile function and quality of life were compared between the two groups.The incidences of postoperative complications such as erectile dysfunction,urinary incontinence and urethral stricture were calculated.Results Operative time,hospital stay,catheter indwelling time,and intraoperative blood loss in the PKRP group were significantly shorter and less than those in the TURP group(t=14.35,8.74,6.20,8.34,all P<0.001).There were no significant differences in residual urine volume and maximum urine flow rate measured before surgery between the two groups(t=0.59,0.73,both P>0.05).After surgery,residual urine volume decreased and maximum urine flow rate increased in each group.Residual urine volume was significantly lower and maximum urine flow rate was significantly higher in the PKRP group compared with the TURP group(t=19.85,11.67,both P<0.001).Before surgery,there were no significant differences in serum prostate-specific antigen and free prostate-specific antigen between the two groups(t=0.43,0.33,both P>0.05).After surgery,both serum prostate-specific antigen and free prostate-specific antigen decreased in each group,and both serum prostate-specific antigen and free prostate-specific antigen were significantly lower in the PKRP group than those in the TURP group(t=16.01,5.09,both P<0.001).Before surgery,there were no significant differences in quality of life(QOL)score and International Index of Erectile Function(IIEF)score between the two groups(t=0.62,0.63,both P>0.05).After surgery,IIEF score was increased and QOL score was decreased in each group.After surgery,IIEF score in the PKRP group was significantly higher than that in the TURP group[(25.06±3.61)points vs.(21.52±3.05)points,t=5.29,P<0.001],and QOL score in the PKRP group was significantly lower than that in the TURP group[(1.05±0.18)points vs.(1.58±0.29)points,t=5.29,10.98,both P<0.001].The incidence of complications in the PKRP group was significantly lower than that in the TURP group(χ^(2)=5.98,P<0.05).Conclusion This study investigated the effects of TURP versus PKRP on giant benign prostatic hyperplasia from the aspects including erectile function,QOL,and perioperative indicators.This study is of certain innovation.Findings from this study confirm that both PKRP and TURP can improve erectile function,serum indicators,and urodynamic indicators in patients with giant benign prostatic hyperplasia.PKRP is preferred because it is less invasive,results in better improvements in erectile function,serum indicators,and urodynamic indicators,and has fewer complications than TURP.