The Effect Of Different Surgical Treatments On BPH And The Influence Of Sexual Function

BackgroundBenign prostatic hyperplasia is a common disease in elderly men.The incidence rate increases with age and seriously affects elderly men's life.BPH mainly causes lower urinary tract symptoms and aggravates with time.The severe cases can manifest as urinary retention and urinary incontinence,which seriously affect the quality of life of patients.Operation is the most reliable way to relieve the obstruction of lower urinary tract.At present,the commonly used methods of operation are transurethral plasma resection of prostate,transurethral laser resection of prostate,transurethral laser enucleation of prostate and transurethral columnar balloon dilatation of prostate.However,different surgical methods have different degrees of influence on the postoperative sexual function of patients,especially for the younger patients with benign prostatic hyperplasia who have normal sexual life before operation,not only hope the postoperative symptoms can be improved,but also hope the postoperative sexual function can be preserved.Therefore,it is an inevitable clinical problem for all urologists to reduce theimpact of surgery on patients' sexual function while ensuring the curative effect.1470 nm diode laser resection and columnar balloon dilatation are relatively new methods in clinical practice,but there are few studies on the therapeutic effect and sexual function related complications.The purpose of this study is to compare the impact of various prostate operations on patients' sexual function after the treatment of BPH,so as to improve the curative effect of prostate operations and reduce the incidence of postoperative sexual dysfunction For theoretical basis,for the majority of urologists reference.In order to explore the role of different surgical methods on sexual function of BPH patients.Methods418 cases of BPH treated in our hospital were collected,including 210 cases of transurethral resection of prostate by plasma,160 cases of transurethral 1470 nm diode laser resection of prostate,and 48 cases of transurethral columnar balloon dilatation of prostate.All patients need close follow-up within 6 months after operation,including ultrasound,Qmax,IPSS,QOL,PSA,PVR,IIEF-5,CIPE.The mean prostate volume,mean age,mean PSA and mean PVR of each group were compared by statistical method,and the consistency of each index before operation was observed to ensure the comparability of each group.By comparing the changes of Qmax,IPSS,QOL,PVR and prostate volume in six months after operation,the therapeutic effects of each group were compared.The complications ofthe three operation methods were compared by the average operation time,average bleeding volume,indwelling catheter time,bladder washing time,capsule perforation,temporary urinary incontinence,reoperation rate and the incidence of electrosurgical syndrome.IIEF-5 and CIPE were used to explore the influence of three operation methods on sexual function.Results1.There was no significant difference in age,preoperative mean prostate volume,Qmax,PVR,IPSS,PSA,IIEF and CIPE among the three groups(P > 0.05).2.In the three group,There was no significant difference in the improvement rate of Qmax,IPSS,QOL and PVR among the three surgical methods(P > 0.05).3.In transurethral resection group,IIEF,CIPE and retrograde ejaculation were reduced by 38.4%,27.9% and 44.28%.In 1470 nm laser resection group,IIEF,CIPE and retrograde ejaculation were reduced by26.1%,28.4% and 34.37%.In columnar balloon dilatation group,IIEF,CIPE and retrograde ejaculation were reduced by 17.5%,20.2% and10.41%.4.The average bleeding volume of laser resection group(106.35 ml ±18.34)was significantly lower than that of the other two groups(P < 0.05).The reoperation rate was 8.5% in the transurethral resection group,which was higher than other groups.The incidence of TUPR syndrome in thetransurethral resection group was 2.8%,higher than that in the 1470 nm laser resection group(1/160).There was no significant difference in urinary tract infection and urethral stricture among the three groups.Conclusion1.The operations in this study can effectively improve the IPSS,QOL,Qmax and PVR of BPH patients.There is no significant difference in the therapeutic effect of three therapies.2.All of three surgical methods have negative effects on the sexual function of the patients.The transurethral columnar balloon dilatation of prostate on the sexual function is relatively low,and there is no significant difference between the transurethral resection and 1470 nm laser resection on the sexual function.3.The bleeding volume of 1470 nm laser resection is the least;the incidence of TURP syndrome of transurethral plasma resection is higher than others;the reoperation rate of the transurethral columnar balloon dilatation of prostate is higher than that the other two operation methods.There was no significant difference in the incidence of urinary tract infection,temporary urinary incontinence and urethral stricture among the three surgical methods.