Department of Urology, Herlev University Hospital, Herlev, Denmark.
J Sex Med. 2014 Feb;11(2):374-85. doi: 10.1111/jsm.12403. Epub 2013 Nov 25.
A series of previously neglected sexually related side effects to radical prostatectomy (RP) has been identified over the recent years. These include orgasm-associated incontinence (OAI), urinary incontinence in relation to sexual stimulation (UISS), altered perception of orgasm, orgasm-associated pain (OAP), penile shortening (PS), and penile deformity.
The aim of this article is to conduct a systematic review of the literature regarding the above-mentioned side effects.
A predefined search strategy was applied in a thorough search of Medline, Web of science, and the online Cochrane library. The PRISMA guidelines for systematic reviews were followed, and protocol as well as search strategies was registered at http://www.crd.york.ac.uk/Prospero/ (RN: CRD42012003165).
The main outcome measure was incidence rates for the relevant side effects.
A total of 43 articles were included. OAI and UISS are experienced by 20-93% of RP patients at least a few times after surgery. Although these issues are associated to postoperative daytime incontinence, previous transurethral resection of the prostate (TURP) is the only known predicting factor. Alterations of orgasmic function are experienced by approximately 80% after RP. Erectile dysfunction seems to play an important role in waning orgasmic function. OAP is only experienced by a subset of the patients with reported rates varying between 3% and 19%. Sparing of the tips of the seminal vesicles has been shown to double the risk of OAP. PS occurs in 15-68% of RP patients. Nerve sparing and preservation of erectile function may help preserve penile length. With regard to all side effects, studies indicate that they are reduced over time.
The sexually related side effects summarized in this review are common after RP. Meanwhile, it is difficult to predict which patients are at risk. Daytime incontinence, previous TURP, a lack of nerve sparing, and erectile dysfunction are all associated with the above-mentioned sexually related side effects.
近年来，人们发现了一系列以前被忽视的根治性前列腺切除术（RP）相关的性副作用。这些副作用包括与射精相关的尿失禁（OAI）、与性刺激相关的尿失禁（UISS）、射精感觉改变、射精相关疼痛（OAP）、阴茎缩短（PS）和阴茎畸形。
本文旨在对上述副作用的相关文献进行系统回顾。
采用预先设定的搜索策略，对 Medline、Web of Science 和在线 Cochrane 图书馆进行全面搜索。本研究遵循 PRISMA 系统评价指南，并在 http://www.crd.york.ac.uk/Prospero/（注册号：CRD42012003165）上注册了方案和搜索策略。
主要观察指标为相关副作用的发生率。
共纳入 43 篇文章。至少有 20-93%的 RP 患者在手术后会出现 OAI 和 UISS，尽管这些问题与术后日间尿失禁有关，但以前的经尿道前列腺切除术（TURP）是唯一已知的预测因素。大约 80%的 RP 患者会出现射精功能改变。勃起功能障碍似乎在射精功能下降中起着重要作用。OAP 仅发生在一部分患者中，报道的发生率在 3%至 19%之间。保留精囊的尖端可使 OAP 的风险增加一倍。15-68%的 RP 患者会出现 PS。保留神经和勃起功能可能有助于保持阴茎长度。关于所有的副作用，研究表明它们会随着时间的推移而减少。
本文总结的 RP 后常见的与性相关的副作用包括，日间尿失禁、以前的 TURP、缺乏神经保留和勃起功能障碍与上述与性相关的副作用有关。
