【探泌】前列腺增生手术：鱼和熊掌不能兼得？
编者按
几十年来，射精功能障碍被认为是前列腺增生患者通过手术恢复正常排尿时“理所应当的代价”，有时还被认为是膀胱出口梗阻完全缓解的标志。在研究术后性功能障碍时，往往过多关注于勃起功能，而射精功能障碍对生活质量影响的研究甚少。然而有研究表明，前列腺增生术后最常见的并发症并不是勃起功能障碍，而是射精功能障碍。Rosen等研究表明，性行为在50岁以上男性中很普遍，并且是其生活质量的重要组成部分，前列腺增生术后射精功能障碍对有规律性行为的男性造成了极大的不良影响，从而导致焦虑和抑郁明显增加。Kim等研究表明，前列腺增生术后性高潮强度的降低是由于射精量减少而不是勃起功能下降导致，射精量减少导致的不适感会降低性高潮强度，排尿症状的改善也会由于性高潮强度的降低而被抵消。
因此，如何保留前列腺增生患者术后正常射精功能显得尤为重要。对此，发表于《World Journal of Urology》杂志题为《Do patients have to choose between ejaculation and miction? A systematic review about ejaculation preservation technics for benign prostatic obstruction surgical treatment》的文章进行了一项系统评价。
【Abstract】
Purpose: Ejaculatory dysfunction is the most common side efect related to surgical treatment of benign prostatic obstruction (BPO). Nowadays, modifed surgical techniques and non-ablative techniques have emerged with the aim of preserving antegrade ejaculation. Our objective was to conduce a systematic review of the literature regarding efcacy on ejaculatory preservation of modifed endoscopic surgical techniques, and mini-invasive non-ablatives techniques for BPO management.
目的：射精功能障碍是良性前列腺梗阻（BPO）手术治疗后最常见的副作用。目前为了保留顺行射精功能，改良的手术技术及非消融技术应运而生。我们旨在对关于改良的内镜手术技术及微创非消融技术保留射精功能疗效的文献进行系统评价。
Methods: A systematic review of the literature was carried out on the PubMed database using the following MESH terms: "Prostatic Hyperplasia/surgery" and "Ejaculation", in combination with the following keywords: "ejaculation preservation", "photoselective vaporization of the prostate", "photoselective vapo-enucleation of the prostate", "holmium laser enucleation of the prostate", "thulium laser", "prostatic artery embolization", "urolift", "rezum", and "aquablation".
方法：以“前列腺增生/手术”和“射精”作为医学主题词，并结合关键词“保留射精功能”、“光选择性前列腺汽化术”、“光选择性前列腺剜除术”、“钬激光前列腺剜除术”、“铥激光”、“前列腺动脉栓塞术”、“urolift”、“rezum”以及“aquablation”对PubMed数据库文献进行系统评价。
Results: The ejaculation preservation rate of modifed-TURP ranged from 66 to 91%. The ejaculation preservation rate of modifed-prostate photo-vaporization ranged from 87 to 96%. The only high level of evidence studies available compared prostatic urethral lift (PUL) and aquablation versus regular TURP in prospective randomized-controlled trials. The ejaculation preservation rate of either PUL or aquablation compared to regular TURP was 100 and 90 versus 34%, respectively.
结果：改良TURP的射精功能保留率为66%-91%。改良光选择性前列腺汽化术的射精功能保留率为87%-96%。唯一可用的高水平证据研究通过前瞻性随机对照试验将前列腺尿道提升术（PUL）和aquablation与常规TURP作了比较。PUL和aquablation的射精功能保留率与常规TURP的相比，分别为100%、90% vs 34%。
Conclusions: Non-ablative therapies and modifed endoscopic surgical techniques seemed to be reasonable options for patients eager to preserve their ejaculatory functions.
结论：对于希望保留射精功能的患者，非消融疗法和改良的内镜手术技术似乎是合理的选择。
译者述评
参考文献：
Lebdai S, Chevrot A, Doizi S, et al. Do patients have to choose between ejaculation and miction? A systematic review about ejaculation preservation technics for benign prostatic obstruction surgical treatment. World J Urol. 2019;37(2):299-308
编译|王冬(陕西中医药大学附属医院)
编辑|榭小仙
审核|张栋邦
