保留膀胱颈完整性的前列腺钬激光剜除术对小体积前列腺增生的疗效及性功能的影响

Effect of holmium laser enucleation of prostate with preservation of bladder neck integrity on small-volume benign prostatic hyperplasia and its influence on sexual function

目的探讨保留膀胱颈完整性的前列腺钬激光剜除术对小体积前列腺增生的疗效,并分析其对性功能的影响。方法选取武汉科技大学附属普仁医院2018年2月至2021年3月就诊的110例小体积前列腺增生患者作为研究对象,根据手术方法将其分成研究组(n=59,行保留膀胱颈完整性的前列腺钬激光剜除术)、对照组(n=51,行传统前列腺钬激光剜除术)。对比两组排尿指标、阴茎勃起功能、精液常规指标及并发症。结果两组术后12个月的最大尿流率及国际勃起功能指数评分简表(IIEF-5)评分均比术前高(P<0.05);两组术后12个月的国际前列腺症状评分(IPSS)、残余尿量均比术前低(P<0.05);研究组精子密度、精子活动率均比对照组高(P<0.05),精子活力分级优于对照组(P<0.05);术后3个月,研究组尿失禁、逆行射精及膀胱颈挛缩发生率均比对照组低(P<0.05)。结论保留膀胱颈完整性的前列腺钬激光剜除术治疗小体积前列腺增生的疗效确切,对术后勃起功能无明显影响,可提高精液质量,且安全可靠。

Objective To investigate the effect of holmium laser enucleation of prostate with preservation of bladder neck integrity on small-volume benign prostatic hyperplasia,and to analyze its effect on sexual function.Methods A total of 110 patients with small-volume benign prostatic hyperplasia who visited Puren Hospital Affiliated to Wuhan University of Science and Technology from February 2018 to March 2021 were selected.They were divided into study group(n=59,holmium laser enucleation of prostate with preservation of bladder neck integrity)and control group(n=51,traditional holmium laser enucleation of prostate)according to different surgical methods.The urination index,penile erectile function,semen routine index and complications were compared between the two groups.Results The maximum urinary flow rate and international erectile function index short scale(IIEF-5)score at 12 months after operation in the two groups were higher than those before operation(P<0.05).The international prostate symptom score(IPSS)and residual urine volume in the two groups at 12 months after operation were lower than those before operation(P<0.05).The sperm density and sperm motility rate in the study group were higher than those in the control group(P<0.05),and the sperm motility classification in the study group was better than that in the control group(P<0.05).Three months after operation,the incidence of urinary incontinence,retrograde ejaculation and bladder neck contracture in the study group were lower than those in the control group(P<0.05).Conclusions Holmium laser enucleation of prostate with preservation of bladder neck integrity is effective in the treatment of small-volume benign prostatic hyperplasia,has no significant effect on postoperative erectile function,can improve semen quality,and is safe and reliable.