Study On The Clinical Application Of Completely Preserving The Ejaculatory Duct During Transurethral Resection Of The Prostate

Objective: To study the feasibility,safety,and effectiveness of transurethral resection of the prostate with an intact ejaculatory tract in the treatment of benign prostatic hyperplasia,and to explore the role of the intact ejaculatory tract to protect patients’ postoperative sexual function.Methods: 1.Feasibility study: The anatomical relationship between the prostate and the ejaculatory structure was studied from three aspects: imaging,solid specimen anatomy,and endoscopic anatomy,to confirm the feasibility of transurethral resection of the prostate with an intact seminal tract.2.Clinical application research: Pick on 70 patients with benign prostatic hyperplasia who met the selection criteria from December 2018 to December 2020 for analysis.Randomly divided into two groups A and B.Group A is the experimental group(35cases)underwent prostatectomy with intact seminal tract,and group B is the control group(35 cases)that underwent traditional prostatic resection;statistics and comparison of group A,The age,prostate volume(PV),PSA,IPSS,QOL,Qmax and IIEF-5,operation time,intraoperative blood loss of the two groups of patients in group B,compare the postoperative bladder irrigation time and hospitalization time of patients in group A and group B.Statistics of IPSS,QOL,Qmax,IIEF-5,semen volume,and the number of cases of retrograde ejaculation that occurred 3 months after the operation.Results: 1.A total of 70 patients with benign prostatic hyperplasia were enrolled.Group A was the experimental group(35 cases)that underwent prostatectomy with intact seminal tract.30 cases were followed up and 5 cases were lost;group B was the control group(35 cases)Traditional electrotonic of the prostate was performed,34 cases were followed up,and 1 case was lost.2.The ages of patients in groups A and B were 63.79±5.34 and 63.42±4.60 years old,respectively;PSA was 7.34±6.07,5.58±4.28 ng·m L-1,respectively;prostate volume(PV)was 50.77±13.92,47.40,respectively ±10.22ml;IPSS were 21.04±5.56,20.68±5.31 points;QOL were 4.71±1.30,4.39±0.99 points;Qmax were 7.27±1.49,7.12± 1.74 m L·s-1;IIEF-5 were 13.85 ±3.04,13.57±2.81 points.According to statistics,there was no statistical difference in preoperative indicators(P>0.05).3.The average operation time of patients in groups A and B were 69.96±18.60 and78.54±20.32 min,respectively.The average operation time of group A was shorter than that of group B.According to statistics,there was no statistical difference(P>0.05).The intraoperative blood loss of patients in groups A and B were 49.96±20.32 and68.54±21.64 ml,respectively.The blood loss of group A was significantly less than that of group B.According to statistics,there was a statistical difference(P<0.05);A,B The bladder irrigation time of the two groups of patients were 3.93±0.94,4.07±0.98 days,and there was no statistical difference(P>0.05)after statistics;the indicators of hospitalization days were 5.82±0.94,6.04±0.92 days,and statistics showed no statistics.Difference(P>0.05).4.The IPSS of the patients in group A before and 3 months after the operation were21.04±5.56 and 6.71±1.82 points,respectively,and the IPSS scores were significantly decreased;QOL was 4.71±1.30,1.36±0.68 points,and QOL was significantly decreased;Qmax was respectively 7.27±1.49,21.09±1.47 m L·s-1,significantly increased,each index was statistically different(P<0.05);IIEF-5 was 13.85±3.04,14.93±3.16 points respectively,there was no statistical difference after statistics(P>0.05).5.The IPSS of patients in group B was 20.68±5.31,6.25±1.71 points before the operation and 3 months after the operation,respectively,which decreased significantly;QOL was 4.39±0.99,1.64±0.83 points,respectively,which decreased significantly;Qmax was 7.12 ± 1.74,respectively 21.91±1.88 m L·s-1,the increase is obvious,statistically,there is a statistical difference(P<0.05);IIEF-5 is 13.57±2.81,14.64±3.41 points,respectively,and there is no statistical difference(P>0.05))6.The IPSS scores of patients in groups A and B were 6.71±1.82,6.25±1.71 points after the operation,respectively;QOL scores were 1.36±0.68,1.64±0.83 points,respectively;Qmax were 21.09±1.47,21.91±1.88 m L·s,respectively-1;IIEF-5 scores were14.93±3.16 and 14.64±3.41 points respectively;after statistics,there was no statistical difference(P>0.05).7.The semen volume of patients in groups A and B were 2.53±0.83 and 1.81±1.14 ml respectively at 3 months after the operation.According to statistics,there was a statistical difference(P<0.05).8.3(10%)patients in group A had retrograde ejaculation 3 months after surgery;21(61.76%)patients in group B had retrograde ejaculation,retrograde ejaculation in group A compared with retrograde ejaculation in group B,retrograde ejaculation The incidence of ejaculation was significantly reduced,and statistically,there was a statistical difference(P<0.05).Conclusion: Resection of the prostate with an intact ejaculatory tract is feasible;compared with traditional transurethral resection of the prostate,this method has the same effect in improving urination symptoms,but patients who use this method are retrograde after surgery.The incidence of ejaculation is significantly reduced.At the same time,this method shortens the operation time,reduces the amount of bleeding during the operation,and has a good application prospect.