McGill Prostate Center, McGill University, Montreal, Quebec, Canada.
Urology. 2012 Nov;80(5):1098-104. doi: 10.1016/j.urology.2012.08.001.
To assess the change and predictors of sexual-related outcomes after laser prostate surgery.
This is a longitudinal study of 216 sexually active men who underwent laser prostatectomy between 2005 and 2010. The International Index of Erectile Function-15 questionnaire was used both preoperatively and during the first year of follow-up. Cases with unreliable answers or patients without interested partners were excluded. All relevant data of both groups were depicted and statistically analyzed.
We identified 191 patients that met the inclusion criteria, 99 holmium laser enucleation of the prostate, 34 holmium laser ablation, and 58 photoselective vaporization of the prostate (GreenLight-532-mm laser photoselective vaporization of the prostate). There were significant differences among the 3 groups regarding the International Index of Erectile Function-15 direction of change at 1 year, being unchanged in (22.2%, 24.4%, and 29.3%), improved in (60.6%, 29.4%, and 41.4), and declined in (17.2%, 41.2%, and 29.3%) in the 3 groups, respectively (P < .05). After adjusting for clinical and perioperative variables, the independent risk factors for decline in the International Index of Erectile Function score were basal International Index of Erectile Function ≥ 55 and energy to prostate ratio. In holmium laser enucleation of the prostate group, there was significant improvement of the mean overall score, erectile function, desire, and intercourse satisfaction domains (P < .05). In holmium laser ablation and photoselective vaporization of the prostate groups, there were no significant changes between mean preopeative and postoperative scores (P > .05). The incidence of new onset retrograde ejaculation in the holmium laser enucleation of the prostate group was (77.3%) significantly different compared to (31.1%) in the holmium laser ablation group and (33.2%) in photoselective vaporization of the prostate group (P < .05).
Laser prostate surgery using more size-related laser energy might have possible negative influence on sexual function. Patients with normal preoperative sexuality are more at risk.
评估激光前列腺手术后与性相关结局的变化及其预测因素。
这是一项对 2005 年至 2010 年间接受激光前列腺切除术的 216 名活跃男性进行的纵向研究。术前和随访的第一年使用国际勃起功能指数-15 问卷。排除回答不可靠或没有感兴趣伴侣的患者。对两组的所有相关数据进行描述和统计分析。
我们确定了 191 名符合纳入标准的患者，99 名接受钬激光前列腺剜除术，34 名接受钬激光消融术，58 名接受绿激光前列腺选择性汽化术（532 毫米绿激光前列腺选择性汽化术）。在 3 组中，国际勃起功能指数-15 变化方向在 1 年时有显著差异，无变化分别为（22.2%、24.4%和 29.3%），改善分别为（60.6%、29.4%和 41.4%），下降分别为（17.2%、41.2%和 29.3%）（P<0.05）。在调整了临床和围手术期变量后，国际勃起功能指数评分下降的独立危险因素是基础国际勃起功能指数≥55 和前列腺能量比。在钬激光前列腺剜除术组中，总体评分、勃起功能、欲望和性交满意度领域的平均评分均显著改善（P<0.05）。在钬激光消融术和绿激光前列腺选择性汽化术组中，术前和术后平均评分之间没有显著变化（P>0.05）。在钬激光前列腺剜除术组中，新发逆行射精的发生率（77.3%）与钬激光消融术组（31.1%）和绿激光前列腺选择性汽化术组（33.2%）相比有显著差异（P<0.05）。
使用与前列腺大小相关的更大激光能量进行激光前列腺手术可能对性功能产生负面影响。术前性功能正常的患者风险更高。
