比较两种前列腺电切术对良性前列腺增生患者术后性功能的影响

目的比较两种前列腺电切术对良性前列腺增生(BPH)患者术后性功能的影响。方法根据不同术式将84例BPH患者分为2组,各42例。A组行经尿道前列腺电切术(TURP),B组行经尿道双极等离子前列腺电切术(PKRP)。比较2组患者治疗前后的前列腺功能、阴茎勃起功能障碍发生率及射精情况。结果 2组治疗后的国际前列腺症状评分表(IPSS)及国际勃起功能指数评分表(IIEF-5)的评分均低于治疗前,差异有统计学意义(P0.05),但IPSS评分差异无统计学意义(P0.05)。B组治疗后的IIEF-5评分高于A组,勃起功能障碍发生率和逆行射精率低于A组,差异均有统计学意义(P0.05)。术后6个月2组逆行射精率差异无统计学意义(P0.05)。结论 PKRP治疗BPH,对术后性功能影响小,患者生活质量高。     

经尿道前列腺等离子双极电切和经尿道前列腺电切治疗良性前列腺增生的临床结果比较

目的比较经尿道前列腺等离子双极电切术(PKRP)与经尿道前列腺电切术(TURP)治疗良性前列腺增生(BPH)的临床疗效及安全性。方法PKRP组78例,TURP组78例,比较2组手术时间、术中出血量,术后国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)及并发症发生率。结果PKRP组手术时间、术中出血量、术后2个月内暂时性尿失禁发生率、术后4周内继发性出血及3个月内尿道狭窄发生率分别为(64±21)min,(247±84)ml,26．9％(21／78),1．3％(1／78)和2．6％(2／78),TURP组分别为(78±18)min,(432±132)ml,48．7％(38／78),10．3％(8／78)和12．8％(10／78),2组比较差异均有统计学意义(P<0．05)。2组均未发生电切综合征(TURS)。PKRP组术后IPSS为4．6±1．2,QOL为1．1±0．8,Qmax为(26．1±4．6)ml／s; TURP组分别为4．8 4±1．1、1．3±0．8、(25．3．4±4．2)ml／s;均较术前明显改善(P<0．01),但组间差异无统计学意义。结论PKRP与TURP比较,治疗BPH疗效相近,但安全性更好,是治疗BPH的理想方法。     

经尿道前列腺电切术与双极等离子电切术治疗良性前列腺增生的临床比较

目的比较经尿道前列腺电切术(TURP)与经尿道前列腺双极等离子电切术(PKRP)治疗良性前列腺增生(BPH)的近期临床疗效、安全性。方法将146例确诊为BPH患者随机分为2组,每组各73例,分别采用PKRP和TURP,2组病例术前前列腺症状评分(IPSS)、生活质量评分(QOL)、剩余尿量(RUV)、最大尿流率(Qmax)比较差异均无统计学意义(P0.05),比较术前术后临床的各项指标及两种手术方法的效果。结果 2组患者手术时间、手术前后血红蛋白变化程度、术前术后血钠浓度差异均有显著性意义(P0.01);术后3、6个月随访,2组IPSS、QOL、RUV均较术前明显下降,Qmax均较术前明显增加,组间比较差异均无统计学意义(P0.05)。术后膀胱冲洗时间、留置导尿时间差异无统计学意义(P0.05)。TURP组并发症发生率27.3%,PKRP组术后并发症发生率8.2%,并发症发生率差异有统计学意义。结论 PKRP与TURP比较,治疗BPH近期疗效相似,但PKRP安全性更高,并发症少。     

腔内剜除法前列腺汽化电切术对患者性功能的影响

目的 评价腔内剜除法经尿道等离子体前列腺汽化电切术(plasmakinetic enucleation of prostate,PKEP)对良性前列腺增生(benign prostatic hyperplasia,BPH)患者性功能的影响.方法 将符合条件的75例患者随机分成常规方法经尿道等离子体前列腺汽化电切术(plasmakinetic raporize of prostate,PKRP)组(35例)及PKEP组(40例),随访两组患者术后6、12个月性欲、勃起功能与射精情况.结果 获完整随访的患者PKRP组31例、PKEP组39例.两组患者随访至术后12个月,阴茎勃起功能障碍(ED)的发生率分别为PKRP组3.2%(1/31)、PKEP组5.1%(2/39),逆行射精(RE)的发生率分别为 PKRP组51.6% (16/31)、PKEP组23.1%(9/39).结论 PKRP与PKEP手术对性功能均有一定的影响,两组ED发生率无明显差异,但RE发生率PKEP明显少于PKRP.     

经尿道等离子双极前列腺切除术与前列腺电切术的疗效比较

目的比较经尿道等离子体双极电切术(PKRP)与经尿道前列腺汽化电切术(TURP)治疗良性前列腺增生症(BPH)的临床疗效。方法将300例有症状的前列腺增生症(BPH)患者随机分成两组,各150例,分别行PKRP和TURP术,记录患者围手术期和术后3个月复查的有关指标(手术时间、术中出血量、冲洗时间、留管时间、住院时间,国际前列腺症状评分(IPSS),尿流率峰值(Qmax)和生活质量评分(QOL)),并发症(TURS、术中输血、继发出血、尿失禁、膀胱痉挛、尿道狭窄)发生率,对两组数据进行统计学分析。结果 PKRP组出血量、冲洗时间、留管时间和住院时间少于TURP组,两组相比差异有显著性(P0.05),术后3个月,两组患者症状评分、生活质量分析、最大尿流率均比术前明显改善(P0.05),PKRP组并发症发生率为3.3%,低于TURP组的13.3%,两组比较差异有统计学意义(P0.05),所有并发症对症处理恢复正常,两组均无死亡病例。结论 PKRP与TURP均是治疗BPH的有效术式,但PKRP较TURP并发症少,安全性高,是治疗BPH较理想的微创术式。     

经尿道前列腺电切术后阴茎勃起功能障碍和射精功能障碍的临床分析

随着人们生活水平的提高,老龄化越来越明显,良性前列腺增生（BPH）患者也日益增多。经尿道前列腺电切术（TURP）术后勃起功能障碍（ED）的发生也越来越受到人们的重视,TURP术后导致ED是临床常见的并发症,如何降低TURP术后ED的发生,已经成为人们关心的问题。2004年6月至2008年7月,笔者应用TURP治疗112例BPH患者,对其阴茎勃起功能及射精功能进行了随访调查,现报告如下。     

经尿道前列腺电切与双极等离子电切对前列腺电切术后尿道狭窄的影响

目的研究经尿道前列腺电切术（TURP）和双极等离子电切术（PKRP）治疗前列腺增生（BPH）与术后尿道狭窄的关系。方法对59例接受TURP患者,36例接受PKRP患者的临床资料进行回顾性研究,分析手术时间、术后冲洗时间、留置尿管时间、术后住院时间、术后6个月尿常规白细胞数等指标与相应的尿道狭窄发生率的关系。结果术前两组一般情况比较无统计学差异（P〉0.05）;手术时间、术后冲洗时间、留置尿管时间、术后住院时间、术后6个月尿常规白细胞数,PKRP组明显优于TURP组（P〈0.05）。术后6个月中,TURP组有10例发生尿道狭窄（16.9%）,而PKRP组则仅为1例（2.8%）（P〈0.05）。Logistic回归分析,TURP组术后留置尿管时间是影响尿道狭窄的主要危险因素,PKRP组各指标对尿道狭窄的发生无明显差异。结论 TURP术后留置尿管时间是导致尿道狭窄的主要因素。PKRP术后尿道狭窄发生率明显低于TURP,有良好的应用前景。     

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。     

经尿道手术治疗良性前列腺增生三种术式的疗效比较

目的比较经尿道电切(TURP)、经尿道汽化电切(TUVP)、经尿道等离子切割(PKRP)3种手术方法治疗良性前列腺增生(BPH)的疗效及并发症。方法分别采用TURP、TUVP、PKRP 3种方式治疗BPH患者545例。TURP组230例,年龄51～87岁(平均73岁),前列腺重量20～138 g(平均50 g);TUVP组250例,年龄49～92岁(平均73岁),前列腺重量22～143 g (平均53 g);PKRP组65例,年龄51～89岁(平均72岁),前列腺重量25～127 g(平均52 g)。3组病例术前前列腺症状评分(IPSS)、剩余尿量(RUV)、最大尿流率(Qmax)、生活质量评分(QOL)比较差异均无统计学意义(P>0.05)。比较3组手术时间、术中出血量、术后尿管留置时间、住院天数、术后并发症发生率及疗效。结果TURP组成功228例(99%);TUVP组成功245例(98%);PKRP组65例均获成功。TURP、TUVP、PKRP组手术时间分别为38(15～90)、41(25～120)、38(17～120) min,组间比较差异无统计学意义(P>0.05);3组术中出血量分别为79(32～310)、75(43～920)、44 (25～156)ml,组间比较差异有统计学意义(P<0.01);3组术后平均留置尿管时间分别为4.1、4.2、3.5 d(P>0.05);3组平均住院时间分别为6.2、6.7、5.1 d(P<0.01)。TURP组发生尿道口狭窄1例、TURS 2例、尿外渗3例,并发症发生率2.6%。TUVP组并发尿道口狭窄7例、后尿道狭窄2例、术中术后出血3例、尿外渗1例、轻度尿失禁1例、附睾炎3例,并发症发生率6.8%。PKRP组术后并发尿外渗2例,并发症发生率3.1%。术后3、6个月随访,3组IPSS、RUV、QOL均较术前明显下降,Qmax均较术前明显增加,但组间比较差异均无统计学意义(P>0.05)。结论3种方法均有明确的临床效果,临床上可根据患者情况和适应证选择不同方法,以获得更好的临床疗效。     

经尿道等离子前列腺汽化电切术与经尿道前列腺电切术的近期疗效比较

目的比较经尿道等离子前列腺汽化电切术（TUPKRP）与经尿道前列腺电切术（TURP）的近期疗效。方法将前列腺增生（benign prostatic hyperplasia，BPH）患者随机分为两组，分别行TUPKRP和TURP，比较两组术前和术后6个月检查的各项指标并进行统计学分析。结果术前两组一般情况比较无统计学意义（P〉0．05）；术后6个月两组国际前列腺症状评分、生活质量评分、最大尿流率比术前均得到明显改善（P〈0．01）；术中输血量、电切综合征发生率、术后平均膀胱冲洗时间、置管时间和住院时间，TUPKRP组明显小于TURP组（P〈0．01）。结论TUPKRP治疗BPH具有与TURP近期疗效相似；术中并发症发生率及患者术后恢复时间明显少于TURP，有良好的应用前景。     

经尿道前列腺等离子剜除术和电切术对前列腺增生患者性功能影响比较的Meta分析

目的探讨经尿道前列腺等离子剜除术（PKEP）与经尿道前列腺等离子电切术（PKRP）对前列腺增生（BPH）患者术后性功能的影响。 方法通过检索PubMed、Cochrane liberary、Springer Link、Web of Science、CNKI、VIP、CBM和万方数据库,查找国内外已发表的关于比较PKEP和PKRP对BPH患者性功能的影响的中英文文献,检索时限为数据库建库至2020年5月1日,试验类型为随机对照试验（RCT）,同时手动检索纳入文献的参考文献。严格按照所指定的纳入排除标准进行筛选,资料提取和质量评价,采用RevMan 5.3统计学软件进行Meta分析。 结果经筛选最终纳入14篇文献,其中中文文献12篇、英文文献2篇,共纳入1 699例研究对象。Meta分析结果显示,术后6个月,PKEP与PKRP相比,IIEF-5评分高[SMD=0.53,95%CI（0.11~ 0.95）,P<0.05],逆行射精发生率少[RR=0.75,95%CI（0.65~0.86）,P<0.05],阴茎勃起功能障碍发生率低[RR=0.78,95%CI（0.68~0.90）,P<0.05]。但在术后12个月,两种手术治疗方式患者IIEF-5评分、逆行射精发生率、阴茎勃起功能障碍发生率差异无统计学意义（P>0.05）。 结论Meta分析表明,与PKRP相比,PKEP术后6个月IIEF-5评分得分高,能明显降低术后逆行射精率,阴茎勃起功能障碍发生率低。     

PKRP、TUVP、SPP 3种前列腺切除术对阴茎勃起和射精功能的影响

目的 比较经尿道前列腺等离子双极电切术(PKRP)、经尿道前列腺汽化术(TUVP)和耻骨上前列腺切除术(SPP) 3种手术方式对BPH患者性功能的影响.方法 将符合此条件的121例前列腺切除患者进行随访,对手术前、后IPSS、性生活、勃起功能(IIEF-5)和射精情况(有无逆行射精、)予以评估.结果 (1)术后3个月3组IPSS评分均有显著下降;(2)3组术后的IIEF-5均有降低,其中SPP组有差异显著的统计学意义;(3) PKRP、TUVP、SPP 3组阴茎勃起功能障碍(ED)发生率分别为:8%、20%、30%:(4)TUVP组和SPP组术后逆行射精(RE)的发生率同术前比较有显著差异.结论 PKRP、TUVP、SPP术对患者性功能均有不同程度的影响,表现在阴茎勃起功能障碍 (ED) 和逆行射精 (RE),而PKRP对性功能的影响较轻.     

三种微创手术治疗前列腺增生症术后性功能比较

目的比较TURP、TVP和TUEVAP治疗BPH术后对性功能的影响。方法分别对各90例TURP、TVP及TUEVAP术后病人追踪观察9个月，总结其术后勃起功能障碍(ED)发生率。结果TURP、TVP及TUEVAP术后ED发生率分别是：11．1％(7／63)、3．17％(2／63)、3．13％(2／64)。逆行射精发生率分别是42．9％(27／63)、44．4％(28／63)、43．8％(28／64)。结论BPH术后ED的发生率，TUEVAP与TVP无显著差别，均优于TURP。三组病人逆行射精发生率无显著性差异。     

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)     

Erectile dysfunction after transurethral resection of the prostate: incidence and risk factors

It is known that a proportion of patients who undergo transurethral resection of the prostate (TURP) will develop erectile dysfunction (ED). This study examined the incidence of ED after TURP using objective and subjective parameters and risk factors for the development of ED. All benign prostate hyperplasia (BPH) patients who were indicated for TURP had to meet the criteria of the International Index of Erectile Function (IIEF) 5 scores of more than 16, and with normal nocturnal penile tumescense (NPT) which had at least one episode of nocturnal erections with both base and tip rigidity exceeding 55% for at least 10 min. The patients nocturnal erection were measured using Rigiscan, over two consecutive nights, approximately 3–4 days preoperatively and 3 months postoperatively. A total of 63 patients were eligible for the study; the mean age was 63.3 years (range 49–85 years). Nine (14%) patients were found to have postoperative ED. Patients who developed ED postoperatively had a lower IIEF-5 score and NPT parameters preoperatively (for all parameters, P<0.0001). For risk factors, diabetes mellitus were found to be a significant independent risk factor. The incidence of ED post-TURP using objective parameters was 14%. Without taking note of the risk factors, TURP is a safe procedure with regard to sexual function.     

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.     

SPP、TURP、HoLEP三种前列腺切除术对性功能的影响

目的比较钬激光前列腺切除术（HoLEP）、经尿道前列腺电切术（TURP）和耻骨上前列腺切除术（SPP）三种手术方式对BPH患者性功能的影响。方法随访92例前列腺切除手术的BPH患者，评价：IPSS、性生活情况、勃起功能（阴茎勃起硬度、IIEF-5）和射精情况（射精有无、精液量、有无逆行射精、有无射精痛）。结果（1）三组术后3月IPSS评分均有显著下降（P〈0．01）；（2）三组术后IIEF-5均有不同程度降低，SPP组与术前比较，差异有显著统计学意义（P〈0．01）。校正可能影响IIEF-5的因素后，三组手术IIEF．5评分改变无统计学差异；（3）HoLEP组、TURP组、SPP组勃起功能下降的发生率分别为：38．1％、28．6％、31．0％，HoLEP、SPP组术后勃起硬度下降明显；（4）HoLEP组和SPP组术后逆行射精发生率较术前有显著差异；（5）三种手术对性欲以及射精量的影响均较小；（6）勃起硬度的降低以及逆行射精的发生三种手术间无明显差异。结论HoLEP术后可导致性功能下降，主要表现在勃起功能降低和逆行射精。HoLEP术对性功能的影响与TURP和SPP相似。     

Comparison of impact of monopolar versus bipolar resection of the prostate on erectile function in patients with benign hyperplasia of the prostate

Introduction and Objective

The incidence of erectile dysfunction (ED) after TURP for BPH is still debated. Current study aims at comparing the impact of monopolar and bipolar TURP on the sexual function of male patients with LUTS, using the IIEF EF-domain score (questions 1–5, 15) and to identify statistical risk factors associated with development of post-operative ED.

不同术式治疗前列腺增生症对性功能影响的观察

目的 比较3种不同术式治疗良性前列腺增生症(BPH)术后对性功能的影响。方法 对40例经尿道前列腺电切术(TURP)和60例耻骨上前列腺切除术(SPPC)与40例改良保留尿道前列腺切除术(MMPC)患者进行9个月的追踪观察，总结其术后勃起功能障碍(ED)及逆行射精发生率。结果 TURP组术后ED发生率增加了35％(14／40)，逆行射精的发生率为50％；SPPC组和MMPC组术后ED的发生率分别增加了为33．33％(20／60)、7．5％(3/40)，逆行射精的发生率分别为62．5％和16％。结论 在治疗前列腺增生症3种术式中，术后性功能损害MMPC组优于TURP组和SPPC组，逆行射精发生率MMPC组也优于其他术式。     

The impact of minimally invasive surgeries for the treatment of symptomatic benign prostatic hyperplasia on male sexual function： a systematic review

A systematic review of randomized controlled trials and cohort studies was conducted to evaluate data for the effects of minimally invasive procedures for treatment of symptomatic benign prostatic hyperplasia （BPH） on male sexual function. The studies searched were trials that enrolled men with symptomatic BPH who were treated with laser surgeries, transurethral microwave therapy （TUMT）, transurethral needle ablation of the prostate （TUNA）, transurethral ethanol ablation of the prostate （TEAP） and high-intensity frequency ultrasound （HIFU）, in comparison with traditional transurethral resection of the prostate （TURP） or sham operations. A total of 72 studies were identified, of which 33 met the inclusion criteria. Of the 33 studies, 21 were concerned with laser surgeries, six with TUMT, four with TUNA and two with TEAP containing information regarding male sexual function. No study is available regarding the effect of HIFU for BPH on male sexual function. Our analysis shows that minimally invasive surgeries for BPH have comparable effects to those of TURP on male erectile function. Collectively, less than 15.4% or 15.2% of patients will have either decrease or increase, respectively, of erectile function after laser procedures, TUMT and TUNA. As observed with TURP, a high incidence of ejaculatory dysfunction （EjD） is common after treatment of BPH with holmium, potassium-titanyl-phosphate and thulium laser therapies （〉 33.6%）. TUMT, TUNA and neodymium：yttrium aluminum garnet visual laser ablation or interstitial laser coagulation for BPH has less incidence of EjD, but these procedures are considered less effective for BPH treatment when compared with TURP.