保留膀胱颈的整块法经尿道前列腺钬激光剜除术对患者性功能影响的研究

A study of the influence on sexual function of Holmium laser enucleation of prostate by using en-bloc and bladder neck preservation technique

目的:评估改良的保留膀胱颈整块法经尿道前列腺钬激光剜除术(holmium laser enucleation of prostate,HoLEP)对良性前列腺增生(benign prostatic hyperplasia,BPH)患者术后性功能的影响。方法:回顾性分析2016年7月—2020年5月在本中心接受保留膀胱颈的整块法经尿道HoLEP治疗的209例BPH患者的临床资料,同期接受传统经尿道前列腺电切术(transurethral resection of the prostate,TURP)的78例患者作为对照。所有患者术前均有性活动并有正常顺行射精。结果:手术时间、术中出血量HoLEP组少于TURP组,差异有统计学意义(P<0.05);HoLEP组住院时间及留置导尿管时间略短于TURP组,但差异无统计学意义(P>0.05);两组并发症无显著差异(P>0.05)。术后即刻尿失禁HoLEP组显著高于TURP组(P<0.05),这种趋势在3个月和6个月时仍有表现,但两组差异逐渐缩小,在术后12个月时尿失禁发生率两组无显著差异(P>0.05)。与术前相比,HoLEP组术后6个月和12个月的国际勃起功能指数问卷表-5(international index of erectile function,,IIEF-5)评分和勃起硬度分级量表(erection hardness grading soale,EHGS)评分均略有改善,但差异无统计学意义(P>0.05)。在TURP组患者观察到相似的情况。以术前及术后12个月作为勃起功能及射精功能的评估节点,结果显示两组患者术前IIEF-5、EHGS没有统计学差异(P>0.05),术后12个月HoLEP组IIEF-5、EHGS高于TURP组,但差异没有统计学意义(P>0.05)。术后HoLEP组逆行射精发生率显著低于TURP组(P<0.05)。结论:保留膀胱颈的整块法HoLEP具有创伤小、切除效率高、并发症发生率低等优点,同时可有效减少逆行射精的发生。

Objective:To evaluate the efficacy and safety of holmium laser enucleation of prostate(HoLEP)by using en-bloc and bladder neck preservation technique and assess the influence on sexual functional outcomes.Methods:Retrospectively analyzed 209 patients who received HoLEP by en-bloc and bladder neck preservation technique from July 2016 to May 2020,and other 78 patients who received traditional transurethral resection of the prostate(TURP)as control.All patients had sexual activity and normal antegrade ejaculation before surgery.Results:The operation time and estimated blood loss in HoLEP group were less than those in the TURP group(P<0.05);The hospital stay and duration of catheterization in HoLEP group were slightly shorter than those in TURP group,but no significant(P>0.05).There was no significant difference in complications between the two groups(P>0.05).The immediate urinary incontinence rate in HoLEP group was significantly higher than that in TURP group(P<0.05).This trend was still manifested at 3 and 6 months,but gradually narrowed and converged at 12 months(P>0.05).The international questionnaire score(IIEF-5)and erection hardness grading scale(EHGS)scores in both groups at 6 and 12 months after surgery were slightly improved(P>0.05).There was no statistical difference in IIEF-5 and EHGS between the two groups before and 12 months after surgery(P>0.05),and IIEF-5 and EHGS in HoLEP group at 12 months after surgery were higher than those in TURP group,but the difference was not statistically significant(P>0.05).The incidence of retrograde ejaculation in HoLEP group was significantly lower than in the TURP group(P<0.05).Conclusions:HoLEP by an en-bloc and bladder neck preservation technique is small-injury and high-efficiency,especially reduce the occurrence of retrograde ejaculation.