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中华腔镜泌尿外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (05) : 453 -458. doi: 10.3877/cma.j.issn.1674-3253.2024.05.006

临床研究

经尿道前列腺剜除术中保留前列腺分叶沟间组织对术后顺行射精功能的保护
程志刚1,(), 魏辉1, 李一波1, 韩健1, 钟永豪1, 王铭1, 张文辉1, 周传东1   
  1. 1. 518027 深圳市福田区第二人民医院泌尿外科
  • 收稿日期:2024-01-02 出版日期:2024-10-01
  • 通信作者: 程志刚

The protection of anterograde ejaculation function after transurethral enucleation of prostate by preserving the tissue between lateral lobe sulci of prostate

Zhigang Cheng1,(), Hui Wei1, Yibo Li1, Jian Han1, Yonghao Zhong1, Ming Wang1, Wenhui Zhang1, Chuandong Zhou1   

  1. 1. Department of Urology, The Second People's Hospital of Futian District, Shenzhen 518027, China
  • Received:2024-01-02 Published:2024-10-01
  • Corresponding author: Zhigang Cheng
引用本文:

程志刚, 魏辉, 李一波, 韩健, 钟永豪, 王铭, 张文辉, 周传东. 经尿道前列腺剜除术中保留前列腺分叶沟间组织对术后顺行射精功能的保护[J]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(05): 453-458.

Zhigang Cheng, Hui Wei, Yibo Li, Jian Han, Yonghao Zhong, Ming Wang, Wenhui Zhang, Chuandong Zhou. The protection of anterograde ejaculation function after transurethral enucleation of prostate by preserving the tissue between lateral lobe sulci of prostate[J]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(05): 453-458.

目的

通过比较保留精阜前方1 cm及周围的组织(保射精技术)与保留分叶沟间的组织(程氏保射精技术)的经尿道等离子前列腺剜除术对术后射精功能的保护差异,并对提出的程氏保射精技术做解剖定位。

方法

回顾性分析2021年4月至2023年3月在深圳市福田区第二人民医院就诊的27例有性活动且射精功能正常的前列腺增生(BPH)患者,年龄(63±5)岁,手术均为同一术者先后采用保射精技术的经尿道等离子前列腺剜除术(Ep组)与程氏保射精技术的经尿道等离子前列腺剜除术(Cheng's组)治疗BPH,其中Ep组14例,Cheng's组13例,分析两组患者术前、术后随访的各项指标。

结果

27例患者均顺利完成手术,随访时间(7.2±1.2)个月;两组术前一般资料比较包括年龄、前列腺体积、国际勃起功能指数-5(IIEF-5)及射精情况调查表、国际前列腺症状评分(IPSS)、生活质量(QOL)评分、最大尿流率(Qmax)、残余尿量(RUV)差异均无统计学意义(P>0.05)。两组术后IPSS、QOL、Qmax、RUV、IIEF-5评分差异无统计学意义(P>0.05);Ep组术后3个月内、7个月后顺行射精均为29%;Cheng's组术后3个月内、7个月后顺行射精均为92%。

结论

经尿道前列腺剜除术中保留前列腺分叶沟间的组织对术后顺行射精功能的保护在近期随访中效果良好。

Objective

To compare the differences in the protection of postoperative ejaculatory function between transurethral plasma kinetic prostatectomy with preservation of 1 cm the tissue in front of colliculus seminalis (ejaculation-preserving technique) and the tissue between the lobular sulci (Cheng's ejaculation-preserving technique), the anatomical position of Cheng's ejaculation-preserving technique was made.

Methods

A retrospective analysis was performed on 27 patients with benign prostatic hyperplasia (BPH), aged (63±5) years, who had sexual activity and normal ejaculatory function and were admitted to the Second People's Hospital of Futian District from April 2021 to March 2023. BPH was treated by transurethral plasma kinetic prostate enucleation (Ep group) with ejaculation-preserving technique and transurethral plasma kinetic prostate enucleation (Cheng's group) with Cheng's ejaculation-preserving technique successfully by the same operator, including 14 cases in Ep group and 13 cases in Cheng's group. Preoperative and postoperative follow-up indexes of the two groups of patients were analyzed.

Results

The operations of all 27 patients was successfully completed. The follow-up time was (7.2±1.2) months. There were no significant differences in preoperative general data between the two groups, including age, prostate volume, international index of erectile function-5 (IIEF-5) and ejaculation status questionnaire, international prostate symptom score (IPSS), quality of life (QOL) score, maximum urine flow rate (Qmax) and residual urine volume (RUV) (P>0.05). During follow-up, IPSS, QOL, Qmax, RUV and IIEF-5 scores were not different significantly between the two groups before and after surgery (P>0.05). In Ep group, the anterograde ejaculation rate was 29% within 3 months and 7 months after operation. The incidence of anterograde ejaculation in Cheng's group was 92% within 3 months and 7 months after surgery.

Conclusion

During transurethral enucleation of the prostate, the preservation of the tissue between the lobular sulci of the prostate has a good effect on the protection of anterograde ejaculation function in short-term follow-up.

图1 经尿道等离子前列腺剜除保射技术(Ep组)治疗前列腺增生关键步骤  图2 经尿道等离子前列腺剜除程氏保射精技术(Cheng's组)治疗前列腺增生关键步骤  图3 尿道背侧纵行肌肉系统(黑色箭头所示)[21,22]注:图1a为Ep组术前在精阜前方1 cm处做切开标记,图1b为Ep组术后保留下来的精阜前方及周围组织;图2a蓝色箭头处为射精管口及直肠指诊时射精管口精液喷出,黄色箭头为射精管口旁分叶沟切开标志点,2b为Cheng's组分别于射精管开口旁的分叶沟稍上方做切开起点,近端至膀胱颈,构成一个三角形,2c为Cheng's组保留下来分叶沟间的组织,图2d为Cheng's组术后腔道通畅,分叶沟组织保留完整;图3a为内镜下尿道肾侧纵行肌,3b为冠状面,3c为矢状面,3d为精阜尾端的横断面;CS为精阜,SD为射精管,P为前列腺,Ms为括约肌,U为尿道
表1 两组保留射精功能的经尿道前列腺剜除术患者术前临床资料对比(±s)
表2 两组保留射精功能的经尿道前列腺剜除术患者术后临床资料对比(±s)
表3 两组保留射精功能的经尿道前列腺剜除术患者术后射精情况对比[例(%)]
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