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中华腔镜泌尿外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (05) : 327 -331. doi: 10.3877/cma.j.issn.1674-3253.2018.05.009

所属专题: 文献

临床研究

前列腺剜除术中保留精阜近端组织对减少低龄患者术后逆行射精的疗效研究
汪洋1, 韩庆平1, 和术臣2, 李海丹2, 叶春伟2, 李志鹏2,()   
  1. 1. 435000 湖北,鄂东医疗集团黄石市中心医院(湖北理工学院附属医院)泌尿外科
    2. 650101 昆明医科大学第二附属医院泌尿外科二病区
  • 收稿日期:2017-03-31 出版日期:2018-10-01
  • 通信作者: 李志鹏

The clinical efficacy of sparing the proximal part of verumontanum for ejaculation preservation in holmium laser enucleation of the prostate

Yang Wang1, Qingping Han1, Shuchen He2, Haidan Li2, Chunwei Ye2, Zhipeng Li2,()   

  1. 1. Department of Urology, Huangshi Central Hospital Affiliated to Hubei Polytechnic University, Huangshi 435000, China
    2. Department of Urology, Second Hospital Affiliated to Kunming Medical University, Kunming 650101, China
  • Received:2017-03-31 Published:2018-10-01
  • Corresponding author: Zhipeng Li
  • About author:
    Corresponding author: Li Zhipeng, Email:
引用本文:

汪洋, 韩庆平, 和术臣, 李海丹, 叶春伟, 李志鹏. 前列腺剜除术中保留精阜近端组织对减少低龄患者术后逆行射精的疗效研究[J]. 中华腔镜泌尿外科杂志(电子版), 2018, 12(05): 327-331.

Yang Wang, Qingping Han, Shuchen He, Haidan Li, Chunwei Ye, Zhipeng Li. The clinical efficacy of sparing the proximal part of verumontanum for ejaculation preservation in holmium laser enucleation of the prostate[J]. Chinese Journal of Endourology(Electronic Edition), 2018, 12(05): 327-331.

目的

探讨前列腺钬激光剜除术(HoLEP)中保留精阜近端组织对减少低龄患者术后逆行射精的临床疗效。

方法

2014年5月至2015年5月间昆明医科大学第二附属医院40例具有性生活及正常射精功能的前列腺增生患者随机分为HoLEP和保留射精功能的HoLEP(EP-HoLEP)两组,各20例,对HoLEP组进行传统的前列腺钬激光剜除术,对EP-HoLEP组进行保留射精功能的前列腺钬激光剜除术,术中保留精阜近端<1 cm范围内的组织及黏膜。记录、分析两组患者术前和术后随访的各项指标。

结果

HoLEP组和EP-HoLEP组术前一般情况比较差异无统计学意义(P>0.05),两组均顺利完成手术。术后随访中,两组最大尿流率(Qmax)、残余尿量(PVR)、国际前列腺症状评分(IPSS)和生活质量评分(QOL)均较术前有明显改善(P<0.01)。两组患者术前精液量分别为(3.1±0.6)ml和(3.4±0.7)ml (P>0.05),而术后12个月分别为(1.2±1.3)ml和(2.3±1.5) ml(P<0.05)。HoLEP组术后12个月逆行射精、顺行射精例数分别为15例(75%)、5例(25%);而EP-HoLEP组分别为8例(40%)、12例(60%),两组间比较差异有统计学意义(P<0.05)。

结论

EP-HoLEP可有效减少前列腺增生患者术后逆行射精的比例,在改善排尿症状方面与传统的HoLEP具有相似的临床疗效。

Objective

To explore the effectiveness of sparing the proximal part of verumontanum for ejaculation preservation in holmium laser enucleation of the prostate (HoLEP).

Methods

From May 2014 to May 2015, 40 sexually active patients with sufficient ejaculate underwent HoLEP. Twenty patients received ejaculation-preserving technique during HoLEP (EP-HoLEP group). The other 20 patients underwent conventional HoLEP (conventional-HoLEP group). In the EP-HoLEP group, the tissue >1 cm proximal to verumontanum was preserved.

Results

There was no significant difference in patient characteristics and perioperative parameters. Preoperatively, the volume of semen were (3.1±0.6) ml in HoLEP group and (3.4±0.7) ml in EP-HoLEP group (P>0.05); 12 months after surgery, there were (1.2±1.3) ml and (2.3±1.5) ml (P<0.05). Success rate of ejaculation preservation were 25% in HoLEP group and 60% in EP-HoLEP group, oppositely,the rate of retrograde ejaculation were 75% and 40% (P<0.05) respectively.

Conclusions

Sparing the proximal part of verumontanum in HoLEP could improve the success rate of ejaculation preservation.

图1 EP-HoLEP示意图:于精阜近端>1 cm处横行切断腺体中叶
图2 HoLEP示意图:于精阜近端处横行切断腺体中叶
表1 两组术前及术后12个月各项指标比较(±s
表2 术后12个月两组逆行射精情况比较[例(%)]
图3 尿道背侧纵行肌肉系统(箭头所示)
[1]
Jaidane M, Arfa NB, Hmida W, et al. Effect of transurethral resection of the prostate on erectile function: a prospective comparative study[J]. Int J Impot Res, 2010, 22(2):146-151.
[2]
Placer J, Salvador C, Planas J, et al. Effects of Holmium laser enucleation of the prostate on sexual function[J]. J Endourol, 2015, 29(3):332-339.
[3]
Elshal AM, Elmansy HM, Elkoushy MA, et al. Male sexual function outcome after three laser prostate surgical techniques: a single center perspective[J].Urology, 2012, 80(5):1098-1104.
[4]
Kim SH, Yang HK, Lee HE, et al. HoLEP does not affect the overall sexual function of BPH patients: a prospective study[J]. Asian J Androl, 2014, 16(6):873-877.
[5]
潘铁军,刘波,文瀚东,等. 保留膀胱颈的前列腺剜除术对性功能的影响及处理[J]. 微创泌尿外科杂志, 2013, 3(2):192-194.
[6]
徐战平,刘久敏,郑祥光, 等.保存膀胱颈完整性在经尿道前列腺等离子电切术中对低龄患者勃起功能的影响[J]. 南方医科大学学报, 2014, 34(11):1702-1704.
[7]
Dorschner W, Stolzenburg JU. A new theory of micturition and urinary continence based on histomorphological studies. 5 The musculus ejaculatorius: a newly described structure responsible for seminal emission and ejaculation[J]. Urol Int, 1994, 53(1):34-37.
[8]
Stockamp K, Schreiter F. Proceedings: function of the posterior urethra in ejaculation and its importance for urine control[J]. Urol Int, 1974, 29(3):226-230.
[9]
Stockamp K, Schreiter F, Altwein JE. Alpha-adrenergic drugs in retrograde ejaculation[J]. Fertil Steril, 1974, 25(9):817-820.
[10]
Rother P, Löffler S, Dorschner W, et al. Anatomic basis of micturition and urinary continence. Muscle systems in urinary bladder neck during ageing[J]. Surg Radiol Anat, 1996, 18(3):173-177.
[11]
Gil-Vernet JM, Alvarez-Vijande R, Gil-Vernet A, et al. Ejaculation in men: a dynamic endorectal ultrasonographical study[J]. Br J Urol, 1994, 73(4):442-448.
[12]
Hermabessiere J, Guy L, Boiteux JP. Human ejaculation: physiology, surgical conservation of ejaculation[J]. Prog Urol, 1999, 9(2):305-309.
[13]
Horenblas S, Meinhardt W, Ijzerman W, et al. Sexuality preserving cystectomy and neobladder: initial results[J]. J Urol, 2001, 166(3):837-840.
[14]
Meinhardt W, Horenblas S. Sexuality preserving cystectomy and neobladder (SPCN): functional results of a neobladder anastomosed to the prostate[J]. Eur Urol, 2003, 43(6):646-650.
[15]
Girgin C, Oder M, Sahin MO, et al. Erection- and ejaculation-preserving cystectomy with orthotopic urinary diversion: is it feasible?[J]. J Androl, 2006, 27(2):263-267.
[16]
Ronzoni G, De Vecchis M. Preservation of anterograde ejaculation after transurethral resection of both the prostate and bladder neck[J]. Br J Urol, 1998, 81(6):830-833.
[17]
Abdel-Basir Sayed M. Bladder neck resection with preservation of antegrade ejaculation: Basir technique[J]. J Endourol, 2003, 17(2):109-111.
[18]
Leonardi R. Preliminary results on selective light vaporization with the side-firing 980nm diode laser in benign prostatic hyperplasia:an ejaculation sparing technique[J]. Prostate Cancer Prostatic Dis, 2009, 12(3):277-280.
[19]
Yang SS, Tsai YC, Chen JJ, et al. Modified transurethral incision of the bladder neck treating primary bladder neck obstruction in young men :A method to improve voiding function and to preserve antegrade ejaculation[J]. Urol Int, 2008; 80(1):26-30.
[20]
Alloussi SH, Lang C, Eichel R, et al. Ejaculation-preserving transurethral resection of prostate and bladder neck: short- and long-term results of a new innovative resection technique[J]. J Endourol, 2014, 28(1):84-89.
[21]
吕蔡,白志明. 激光技术在前列腺增生治疗中的应用[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2014, 8(1):65-68.
[22]
魏海彬,孙丰,邵怡, 等. 铥激光在前列腺增生治疗中的应用与进展[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2014, 8(1):61-64.
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