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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。
Objective To compare the effects of holmium laser prostatectomy (HoLEP), transurethral resection of the prostate (TURP) and suprapubic prostatectomy (SPP) on the sexual function of patients with BPH. Methods: A total of 92 BPH patients undergoing prostatectomy were followed up for evaluation of IPSS, sex life, erectile function (penile erection hardness, IIEF-5) and ejaculation (ejaculation, semen volume, retrograde ejaculation, ). Results (1) The IPSS scores of all three groups were significantly decreased at 3 months after operation (P <0.01). (2) The levels of IIEF-5 decreased in all three groups after operation. The difference was statistically significant Significance (P <0.01). There was no significant difference in the IIEF-5 score between the three groups after correction of factors that may affect the IIEF-5. (3) The incidences of erectile dysfunction in the HoLEP, TURP and SPP groups were 38.1%, 28.6% and 31.0 %, HoLEP, SPP group erectile stiffness decreased significantly; (4) HoLEP group and SPP group postoperative retrograde ejaculation incidence was significantly different from preoperative; (5) The three kinds of surgery on sexual desire and ejaculation volume were small ; (6) reduce the erectile stiffness and the occurrence of retrograde ejaculation no significant difference between the three operations. Conclusion HoLEP can lead to decreased sexual function, mainly in erectile dysfunction and retrograde ejaculation. The effect of HoLEP on sexual function is similar to that of TURP and SPP.