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。

The impact of SPP, TURP and HoLEP on male sexual function

Objective To assess effects of three types of prostatecomy,holmium laser enucleation of prostate(HoLEP),transuretheral resection of prostate(TURP)and suprapubic prostatectomy(SPP)on BPH patients'sexual function.Methods Follow-up research data of 92 consecutive patients with BPH admitted for prostatecomy were collected,including IPSS,sexual life,erectile function(erectile stiffness,IIEF-5),ejaculatory function(retrograde ejaculation,painess of ejaculatory,volume of ejaculation).Results(1)The score of IPSS in three groups all decreased rapidly in postoperative 3 months,which showed statistical significant difference(P<0.01);(2)The declination extent of IIEF-5 among 3 groups were different.Only SPP group showed statistical significant difference.After adjusted the possible influencing factors on IIEF-5 by statistics,there was no statistical difference on the change of IIEF-5 in all three groups;(3)The incidence of erectile dysfunction in HoLEP,TURP,SPP group was 38.1%,28.6%,31.0% respectively.HoLEP and TURP group showed statistical difference;(4)The incidence of retrograde ejaculation of HoLEP and TURP group showed statistical significant difference before and after surgery;(5)There was no difference on change of libido and volume of ejaculation in each group;(6)There was no statistical difference on erectile dysfunction and retrograde ejaculation in three groups.Conclusion HoLEP may affect sexual function,primarily results in erectile dysfunction and retrograde ejaculation.The impact of HoLEP on sexual function is similar with TURP and SPP.