经尿道前列腺汽化电切术对勃起功能的影响

目的 探讨经尿道前列腺汽化电切术（TUVP）对勃起功能的影响。方法 调查随访586例TUVP术患者。按年龄、术前勃起功能情况、术前术后前列腺症状评分（IPSS）、前列腺切除重量、术中是否有前列腺包膜穿孔、术中是否发生经尿道电切综合征（TURS）、术前是否进行心理疏导7个因素，分别比较其影响下的勃起功能变化情况。结果 术中前列腺切除重量、术中是否发生TURS对术后勃起功能障碍的发生无明显影响（P〉0．05）；患者年龄〉70岁、术前有勃起功能障碍、术中有前列腺包膜穿孔、手术前后IPSS分值差〈10分及术前未进行心理疏导与术后勃起功能障碍的发生有明显的关系（P〈0．05）。结论 年龄、术前性功能状况、术中是否有前列腺包膜穿孔、术前术后排尿情况变化及是否进行心理疏导这5个因素对术后勃起功能有明显影响。     

前列腺电切术对勃起功能的影响(附64例报告)

目的:分析经尿道前列腺电切术(TURP)对勃起功能的影响程度及引起术后勃起功能障碍(ED)的因素。方法:对64例老年前列腺增生患者TURP术前及术后3个月进行阴茎夜间勃起功能(NPT)检测、勃起功能国际问卷(IIEF-5)、焦虑自评量表(SAS)评估。结果:术中穿破前列腺包膜者较包膜完整者ED发生率比后者高(9/15 vs 11/49,P<0.05),术后SAS评分较术前明显升高(44.01±6.21 vs 38.28±5.66,P<0.01)。IIEF-5评分术后较术前降低,其差异具有统计学意义(19.06±4.55 vs 22.56±0.54,P<0.01)。结论:术中是否穿破前列腺包膜、术后焦虑心理因素对TURP术后勃起功能障碍影响明显。     

经尿道前列腺等离子双极电切术对阴茎勃起功能的影响(附100例报告)

目的:比较经尿道前列腺电切术(TURP)和经尿道前列腺等离子双极电切术(PKRP)治疗BPH后对患者阴茎勃起功能的影响,并探讨各自相关影响因素。方法:按1∶1比例随机分为TURP组和PKRP组,用勃起功能国际问卷(IIEF25)和Rigiscan硬度仪评测患者术前术后性功能变化;记录IIEF25评分、患者年龄、切除前列腺大小、手术时间、术中出血量、包膜损伤、逆行射精、电切综合征(TURS)等可能影响性功能的因素进行变量逻辑回归分析。结果:TURP组术后6个月有9例(18.0%)、PKRP组有5例(10.0%)发生阴茎勃起功能障碍(ED),术后ED与患者年龄、术前IIEF25评分、逆行射精及包膜损伤有显著相关性。结论:TURP、PKRP术对患者性功能均有不同程度的影响,而PKRP对性功能的影响较轻微;影响术后性功能比较显著的因素为患者年龄、包膜损伤、逆行射精和术前IIEF25评分。     

不同途径前列腺切除术后发生性功能障碍的比较

目的:探讨耻骨上经膀胱前列腺切除术(SPP)、经尿道前列腺电切术(TURP)、经尿道前列腺电气化联合电切术(TUVP加TURP)治疗BPH对患者性功能的影响。方法:采用国际勃起功能问卷简化表(IIEF5)通过调查问卷方式,对104例接受上述手术的BPH患者术前、术后6个月勃起功能及逆行射精情况进行问卷评分。结果:SPP、TURP、TUVP加TURP三组患者术前IIEF5评分分别为17.4、17.9、18.1分,术后6个月IIEF5评分分别为11.7、13.2、10.2分,手术前后比较差别有统计学意义(P<0.05)。三组之间IIEF5评分降低程度比较TUVP加TURP>SPP>TURP,差别有统计学意义(P<0.05)。三组术后逆行射精的发生率分别为23.1%、32.5%、25.0%。结论:三组手术均可导致患者勃起功能障碍的发生,其中以TUVP加TURP发生率最高,逆行射精发生率以TURP最高。提高手术操作技巧,避免包膜损伤,作好解释工作,可减少术后患者勃起功能障碍的发生。     

经尿道前列腺切除加膀胱颈内切开术对性功能的影响

目的探讨经尿道前列腺切除加膀胱颈内切开术(TURP TUIBN)对性功能的影响。方法对术前有正常性生活、年龄在75岁以下的23例前列腺增生患者行TURP TUIBN治疗(联用组),随访了解术后6个月以后的性功能情况。并与28例同期单纯行TURP、切除前列腺重量小于20g的患者(TURP组)进行比较。结果联用组与TURP组逆行射精(RJ)发生率分别为60.9%和57.1%;勃起功能障碍(ED)发生率分别为8.7%和10.7%。结论TURP TUIBN不增加逆行射精及勃起功能障碍的发生率;与TURP比较,TURP TUIBN对性功能无明显影响。     

TURP术后性功能状况评估:一项多中心前瞻性独立研究结果

经尿道前列腺电切术（TURP）是否会影响BPH患者的性功能状况,目前还无法得出肯定的结论。现已知TURP可以导致术后逆行射精的发生．但是否对勃起功能有影响仍存在分歧。本研究针对TURP手术患者的射精功能和勃起功能情况进行了分析。     

经尿道前列腺电切术与等离子电切术对前列腺增生术后性功能影响的研究

目的回顾性比较良性前列腺增生(BPH)患者经尿道前列腺电切术(TURP)或经尿道前列腺等离子电切术(TUPRP)治疗后性功能情况。方法选择150例接受TURP和110例TUPRP的良性前列腺增生患者,分析不同手术方式的患者术后性功能的差异。结果 TUPRP组患者的术后IIEF-5评分显著高于TURP组患者(23.1 vs.20.1,P0.05)。TUPRP组患者术后勃起功能障碍发生率显著低于TURP组患者(10.7%vs.16.4%,P0.05)。两组患者术后逆行射精和性欲下降的差异无统计学意义(P0.05)。结论相对于TURP,TUPRP对BPH患者术后勃起功能的影响较小。     

经尿道前列腺电切术后尿道狭窄发生的危险因素

目的 探讨经尿道前列腺电切术(TURP)后尿道狭窄发生的危险因素。方法 对200例诊断为良性前列腺增生症病人行经尿道前列腺电切术后随访12月～18月,对可能影响术后尿道狭窄的因素以Lo-gistic回归模型做单因素分析以及用逐步回归法行多因素分析。结果 本组共155例患者获完整随访,其中12例术后出现尿道狭窄,发生率为7.74%。术前尿路感染、术后留置尿管时间长短、手术切除前列腺重量三因素与术后尿道狭窄相关,相对危险度分别为9.305、2.973和5.587,有统计学意义(P<0.05)。结论 术前尿路感染、术后尿管留置时间的长短、手术切除前列腺的重量依次是TURP术后出现尿道狭窄的主要危险因素。     

经尿道前列腺切除术对性功能影响的Meta分析

目的:探讨经尿道前列腺电切术(TURP)、前列腺电汽化术(TUEVP)和钬激光前列腺剜除术(Ho-LEP)治疗良性前列腺增生(BPH)对男性性功能的影响。方法:搜集比较TURP、TUEVP及HoLEP对性功能影响的随机对照研究(RCT),以Meta分析法系统比较不同术式治疗BPH对性功能的影响。结果:9个RCT研究1 050例患者纳入分析,研究基线具有可比性。TURP与TUEVP相比,对勃起功能影响较小(P=0.04),对射精功能的影响无显著差异。HoLEP和TURP在术后12个月和24个月对勃起和射精功能的影响均无显著差异。结论:TUEVP比TURP更易引起勃起功能障碍,但对射精功能的影响无明显差别;HoLEP与TURP对勃起和射精功能的影响无明显差别。     

经尿道前列腺电切术后低血压相关因素分析

目的通过分析经尿道前列腺电切(TURP)术后低血压的相关危险因素,探讨TURP术后低血压的预防对策。方法对重庆永荣矿业公司总医院61例TURP术后发生低血压患者与86例未发生低血压患者的年龄、手术总时间、前列腺切除重量、包膜切穿后手术时间、失血量、术后血钠浓度、术后体温采用logistic回归分析。结果统计结果显示,包膜切穿后手术时间长、失血量大、术后血钠浓度低、术后体温低是术后低血压的危险因素,而患者年龄、手术总时间、前列腺切除重量与术后低血压不相关。结论 TURP术中应采取各种措施避免切穿前列腺包膜、减少水吸收、减少失血量,提高手术技巧、膀胱造瘘术、加热膀胱冲洗液能够有效预防术后低血压。     

经尿道等离子双极电切术和TURP治疗BPH术后阴茎勃起功能障碍的比较

目的探讨经尿道等离子双极电切术(PKRP)治疗良性前列腺增生(BPH)术后对阴茎勃起功能的影响。方法PKRP、经尿道前列腺电切术(TURP)治疗BPH各95例,评价其术后1个月、3个月及1年阴茎勃起功能。结果PKRP、TURP术后1个月、3个月及1年阴茎勃起功能障碍(ED)发生率分别是3．2％、2．1％、2．1％和13．7％、10．5％、9．5％。结论PKRP术后ED发生率比TURP低,是一种对阴茎勃起功能较为安全的治疗良性前列腺增生的方法。     

Erectile Dysfunction Following Transurethral Resection of the Prostate

Purpose

We objectively measured the incidence of erectile dysfunction following transurethral resection of the prostate.

Materials and Methods

A total of 56 men completed a questionnaire detailing perceived sexual dysfunction, and underwent nocturnal penile tumescence testing for 3 nights before transurethral resection of the prostate and again at 3 months postoperatively.

Results

Complete data were available for 40 men. No significant difference was found in penile tumescence, number of erectile events and duration of events before and after surgery. Preoperative and postoperative rigidity was statistically different, with a slight improvement after transurethral resection of the prostate (p less than 0.05). A subjective decrease in quality of erection after transurethral resection of the prostate was reported in 27.5 percent of the patients. However, on further questioning, 63.6 percent of these patients equated retrograde ejaculation with decreased potency.

Conclusions

We demonstrated no decrease in objective parameters of erectile function studies following transurethral resection of the prostate. Previous estimates of impotence after transurethral prostatectomy may have been tainted by subjective patient reports equating retrograde ejaculation with erectile dysfunction.     

Erectile dysfunction after transurethral prostatectomy for lower urinary tract symptoms： results from a center with over 500 patients

Aim:To identify possible risk factors for erectile dysfunction(ED)after transurethral resection of prostate(TURP)for benign prostatic hyperplasia(BPH).Methods:Between March 1999 and March 2004,629 patients underwentTURP in our department for the treatment of symptomatic BPH.All patients underwent transrectal ultrasoundexamination.In addition,the flow rate,urine residue,International Prostate Symptom Score(IPSS)and quality of life(QOL)were recorded for those who presented without a catheter.Finally,the erectile function of the patient wasevaluated according to the International Index of Erectile Function Instrument(IIEF-5)questionnaire.It was deter-mined that ED existed where there was a total score of less than 21.The flow rate,IPSS and QOL assessment wereperformed at 3 and 6 months post-treatment.The IIEF-5 assessment was repeated at a 6-month follow-up.A logisticregression analysis was used to identify potential risk factors for ED.Results:At baseline,522(83%)patientsanswered the IIEF-5 questionnaire.The mean patient age was(63.7±9.7)years.The ED rate was 65%.After 6months,459(88%)out of the 522 patients returned the IIEF questionnaire.The rest of the group was excluded fromthe statistical analysis.Six months after TURP,the rate of patients reporting ED increased to 77%.Statisticalanalysis revealed that the only important factors associated with newly reported ED after TURP were diabetes mellitus(P=0.003,r=3.67)and observed intraoperative capsular perforation(P=0.02,r=1.12).Conclusion:Theincidence of postoperative,newly reported ED after TURP was 12%.Risk factors for its occurrence were diabetesmellitus and intraoperative capsular perforation.(Asian J Androl 2006 Jan;8:69-74)     

硝普钠阴茎海绵体内注射治疗阳萎的临床研究

本研究选择４２例阳萎患者，采用硝普钠进行阴茎海绵体注射（ＩＣＩ），并选择罂粟碱／酚妥拉明进行对照，结果表明，硝普钠ＩＣＩ后：（１）阴茎外形性状（长度、周径等）明显改变。（２）Ｖｉｒａｇ硬度计点表明硝普钠与罂粟碱／酚妥拉明效果之间无明显差别。（３）所有测试患者无一例出现低血压或局部不适等副反应，与罂粟碱／酚妥拉明相比各有优劣，但总体差异不大，这充分表明，硝普钠作为一种ＮＯ供体可导致阴茎平滑肌松弛，血窦充盈阴茎勃起，其副反应较小，有其临床应用之价值。     

Results of deep dorsal vein ligation for venogenic impotence]

We treated seventy venogenic impotence with ligation of the deep dorsal vein of the penis. Their corporal veno-occlusive function was evaluated by dynamic infusion cavernosometry and cavernosography (DICC). Under local anesthesia, we made a longitudinal skin incision at the base of the penis. The deep dorsal vein was ligated and also a portion of this vein of 1.5 cm long was resected together with branches surrounding the vein. After the operation, the infusion rate determined by DICC was confirmed to be decreased in almost all patients. Thirty nine out of seventy cases had their erectile capability restored and reported that they could achieve sexual intercourse. Sixty one of the seventy cases showed full erection together with an intracavernous papaverine injection. However fifty percent of the sixty one patients who became capable of obtaining erection with the treatment had lost their erectile capability again within one year of the operation, however the other fifty percent were shown to maintain their erectile capability for up to three years. As four years after the treatment only thirty percent of those who had achieved the initial erectile capability still remained potent. This operation is easy to perform without any major complications, and its outcome is as good as that achieved by other more invasive venous ligation in the treatment of patients with venogenic impotence. We therefore conclude that penile deep dorsal vein ligation and partial resection of the vein one of the most useful treatments currently available for venogenic impotence and should be the treatment of choice.     

两种经尿道前列腺切除术治疗良性前列腺增生症的疗效比较

目的比较经尿道前列腺电切术（TURP）与经尿道双极等离子前列腺切除术（PKRP）治疗良性前列腺增生症（BPH）的优缺点。方法分别采用TURP（357例）、PKRP（326例）治疗BPH,观察两组患者手术前后国际前列腺症状评分（IPSS）、生活质量评分（QOLS）、最大尿流率（MFR）、残余尿（RUV）的改善情况以及术后并发症的发生情况。结果两种术式患者术后IPSS、QOLS、MFR、RUV均得到显著改善,组间差异无显著性（P〉0．05）。对Ⅰ～Ⅱ度前列腺增生,两组术式手术时间无差异;对Ⅲ度前列腺增生,TURP组手术时间短于PKRP组（P〈0．01）。两组术式术中切除前列组织重量、术中出血及术后主要观察指标差异均无显著性。TURP组3例发生电切综合症,2例因前列腺包膜穿孔中转开放手术,而PKRP组无上述情况发生。PKRP组术后并发症少于TURP组。结论TURP及PKRP均为治疗BPH的有效手段,PKRP较之TURP术中更为安全,手术后并发症较少,但手术时间较长。     

Impaired nocturnal erections and impotence following transurethral prostatectomy

A case of impotence with significantly impaired nocturnal penile tumescence (NPT) following transurethral resection of the prostate (TURP) is described. The patient was studied with polysomnographic recording including measurements of NPT for three consecutive nights at nine months after surgery and showed a total absence of full erections. Possible causes of his impotence are discussed. It is concluded that the total clinical picture strongly suggests that the erectile dysfunction was a result of physiologic complications of the surgery. Methodologic problems in past work are discussed, and the need for detailed diagnostic studies is stressed. The sleep studies that should be a part of this comprehensive evaluation are described.     

Sexual function of LUTS patients before and after neodymium laser prostatectomy and transurethral resection of prostate. A prospective, randomized trial

OBJECTIVE: To assess and compare the sexual function of patients undergoing transurethral resection of the prostate (TURP) or Nd:YAG laser treatment for lower urinary tract symptoms (LUTS) caused by obstructing benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: 98 LUTS patients with urodynamically confirmed bladder outlet obstruction were recruited. Patients were randomised to TURP and laser treatment, which was further divided to contact and hybrid treatments according to prostate size. The sexual function at baseline and at 1 year postoperatively was assessed from the Danish Prostate Symptom Score Sexual Function Questionnaire (DanPSS Sex) items concerned with erectile stiffness, ejaculatory volume and pain or discomfort on ejaculation. RESULTS: The sexual function data at 1 year was available for 83 patients. At baseline, a high prevalence of erectile dysfunction (86%), ejaculatory volume change (83%) and pain or discomfort on ejaculation (26%) was observed and considered problematic by 79%, 63% and 100% of men, respectively. An increase of total impotence in the TURP group was observed (p = 0.046). TURP decreased or totally eradicated the amount of ejaculate, which was the only difference found between the study groups (p < 0.001). Both laser and TURP treatments improved pain or discomfort on ejaculation. CONCLUSIONS: The prevalence of sexual dysfunction in patients with symptomatic infravesical obstruction caused by BPH is high and perceived mostly as bothersome. TURP, Nd:YAG contact or hybrid laser treatments did not increase erectile dysfunction but improved pain or discomfort on ejaculation. The only significant difference between these treatments in respect to sexual function was a higher incidence of decreased or absent ejaculate after TURP.     

Effects of prostatectomy on sexual function

We evaluated the effects of prostatectomy on sexual function in 210 patients, 49.6 percent of whom underwent transurethral resection of the prostate (TURP), and the remainder had suprapubic transvesical prostatectomy (SPP). Pre- and postoperative interviews with detailed questionnaires were utilized. Postoperative sexual dysfunction was reported by 18 of 152 patients (11.8%) who were functioning normally prior to surgery. The incidence of postoperative impotence was evenly distributed between the TURP and SPP groups and was age-related; it was highest among older patients. We further observed a strong correlation between the presence of a permanent sexual partner and the preservation of potency. We conclude that the risk of postoperative impotence is dependent on both the patient's age and the presence of a partner, and should be discussed with the patient preoperatively.