Impact of complete bladder neck preservation on bladder neck contracture and sexual function after holmium laser enucleation of small prostate
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摘要: 目的:研究分析小前列腺(≤40 g)中保留膀胱颈完整性的经尿道前列腺钬激光剜除术(HoLEP)与传统钬激光前列腺切除术(HoLRP)患者术后尿失禁、膀胱颈挛缩(BNC)、性功能的影响。方法:回顾性分析2016年2月—2019年5月在我院诊断为BPH的135例患者的临床资料,随机将患者分为进行了保留膀胱颈HoLEP的A组和传统HoLRP的B组。统计分析患者术前以及术后1、3、6、12个月的国际勃起功能指数-5(IIEF-5)评分、勃起硬度评分(EHS)模型、逆行射精情况来评价患者性功能,国际前列腺症状评分(IPSS)、生活质量(QOL)评分、最大尿流率(Qmax)、排尿后残余尿量(PVR)及尿失禁、膀胱颈挛缩并发症发生率。结果:A组和B组患者围手术期IPSS、IIEF-5评分、QOL评分、Qmax、排尿后PVR比较差异均无统计学意义。在12个月的随访中,评估术后两组的IPSS、QOL评分、Qmax、PVR较术前均有显著改善,术后组间差异亦无统计学意义。两组围手术期手术时间、总前列腺切除腺体重量、导尿管留置时间、住院时间、血红蛋白下降情况统计学上均无明显差异。术后膀胱颈部开口直径B组显著大于A组,差异有统计学意义(P＜0.05)。在1~12个月的随访中,A组的逆行射精率低于B组。早期1~3个月的随访尿失禁率A组低于B组(P＜0.05)。在6个月和12个月的随访中,两组尿失禁比较差异无统计学意义。在12个月随访中,A组中有2例(2.7%)发生BNC,而B组中有8例(12.7%)发生BNC,差异有统计学意义(P=0.028 1)。两组的手术前后及组间分析发现IIEF-5、EHS评分比较差异无统计学意义。结论:HoLEP术中注意保留膀胱颈完整性可以显著降低小前列腺患者的BNC风险,减少术后早期尿失禁和减少逆行射精有效,对长期尿失禁无明显影响,对患者术后勃起功能无明显影响。Abstract: Objective: To analyze the impact of preserving complete bladder neck on postoperative urinary incontinence, bladder neck contracture(BNC), sexual function in transurethral holmium laser enucleation of the prostate(HoLEP) and traditional holmium laser resection of the prostate in small prostate(≤40 g) patients.Methods: This is a retrospective study, which divided 135 patients with small prostate into two groups: Group A and Group B performed bladder neck-preserving HoLEP and traditional HoLRP respectively. Patients' international index of erectile function 5(IIEF-5 score), erection hardness score(EHS) model, retrograde ejaculation before operation and 1, 3, 6, and 12 months after operation were statistically analysed to evaluate the patient's sexual function, and International Prostate Symptom Score(IPSS), Quality of Life(QOL) Score, maximum urinary flow rate(Qmax), postvoid residual(PVR) volume and complications of urinary incontinence and bladder neck contracture incidence rate were also recorded.Results: The perioperative IPSS, IIEF-5, QOL, Qmax and PVR of patients in group A(HoLEP) and group B(traditional HoLRP) were not statistically significant. During the 12-month follow-up, the postoperative IPSS, QOL, Qmax and PVR of the two groups significantly improved compared with those before the operation, and there was no statistically significant difference between the groups after the operation. There was no statistically significant difference in perioperative time, prostate gland resection weight, catheter retention time, hospital stay or hemoglobin decline between the two groups. Postoperative bladder neck opening diameter of group B was significantly larger than that of group A, with statistical significance. During the follow-up from January to December, the retrograde ejaculation rate of group A was lower than that of group B. Early 1-month to 3-month follow-up urinary incontinence rate of group A was lower than that group B, with a P value of less than 0.05. During the 6-month and 12-month follow-up, there was no statistical difference between the two groups in urinary incontinence. During the 12-month follow-up, there were 2 cases of BNC(2.7%) in group A, and 8 cases of BNC(12.7%) in group B. The difference was statistically significant(P=0.028 1). The analysis of the two groups before and after the operation and between the groups found that IIEF-5 and EHS scores were similar without statistical significance.Conclusion: Intraoperative preservation of the complete bladder neck in HoLEP can significantly reduce the risk of BNC in patients with small prostate, reduce early postoperative urinary incontinence and reduce retrograde ejaculation. It has no significant effect on long-term urinary incontinence or postoperative erectile function.
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