Pavone Carlo, Abbadessa Daniela, Scaduto Giovanna, Caruana Giovanni, Scalici Gesolfo Cristina, Fontana Dario, Vaccarella Luigi
Section of Urology, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo.
Arch Ital Urol Androl. 2015 Mar 31;87(1):8-13. doi: 10.4081/aiua.2015.1.8.
Benign prostatic hyperplasia (BPH) and sexual dysfunctions are diseases with a high prevalence in aged men. Several studies have found a link between BPH and LUTS resulting from deterioration in sexual function in men aged 50 years and older for whom TURP is considered the gold standard. The impact of TURP on sexual functions still remain uncertain, nor is it clear what pathophysiological mechanism underlying the emergence of new episodes of Erectile Dysfunction (ED) following TURP in patients with normal sexual function before surgery, while retrograde ejaculation and ejaculate volume reduction represent a clear side effect; derived from BPH treatment. The aim of this study was to retrospectively evaluate the effects of transurethral resection of the prostate (TURP) on sexual function in patients operated in the period 2008-2012 at the Department of Urology of the University Hospital P. Giaccone, and at Villa Sofia-Cervello Hospital- Palermo. Secondary objective was to reconnect the sample data to interventional practice and international standards.
The retrospective longitudinal study was conducted on 264 of the 287 recruitable patients, aged between 50 and 85 years, suffering from BPH who underwent to TURP in the period 2008-2012. Telephone interviews were conducted and the International Index of Erectile Function (IIEF) was administered to assess sexual function. Patients enrolled were asked to respond to the test by referring at first to their sexual status in the period before surgery and subsequently to the state of their sexual function after treatment so as to obtain, for each patient, a pre- and post-TURP questionnaire in order to get comparisons that corresponding to reality and to avoid overestimation of the dysfunctional phenomenon.
In the pre-TURP, the 94.32% of the sample reported being sexually active, with good erectile function in 41.3% of cases, ED mild/moderate in 51.5% and complete ED in 1, 5% of cases; good libido in 62.9% of cases, lack of libido in 31.4% of cases and absent in 5.7% of cases (the latter data corresponded to patients not sexually active); to be sexually satisfied in 29.5% of cases, slightly dissatisfied in 11, 7% of cases, moderately in 35.3% of cases, dissatisfied and very dissatisfied in 23.5% of cases (of which 17.8% sexually active and 5.7% non-active). In the post-TURP 89.4% of the sample reported being sexually active, with good erectile function in 39.1% of cases, DE mild/moderate in 46.9% and complete DE in 4% of cases; good libido in 53.8% of cases, lack of libido in 33.7% of cases and absent in 13.5% of cases (including 1.9% of sexually active and 10.6% of non-active); to be sexually satisfied in 29.5% of cases, slightly dissatisfied in 9.5% of cases, moderately in 35.3% of cases, dissatisfied and very dissatisfied in 17.8% of cases (of which 14.8% sexually active and 10.6% inactive). Retrograde ejaculation was referred in 47.8% of those sexually active after TURP (42.8% if we consider the whole sample).
TURP had no negative impact on erectile function in contrast to ejaculatory function. Of the 109 patients with good erectile function in pre-TURP, 5.8% reported a worsening of erectile function after TURP. Among the 136 patients with ED moderate/mild pre-TURP 3.7% reported a worsening in the post-TURP, 16.2% reported an improvement, while 9.5% stopped any sexual activity. In 3.7% of the cases a complete ED was reported after TURP, while a decline of libido and sexual satisfaction was detected in all patients with worsening of sexual function. Retrograde ejaculation was observed in 48% of those sexually active after TURP. Particular attention has to be paid to the psychological aspects, both before surgery and in the postoperative period, which may become an important factor in the decline of sexual activity.
良性前列腺增生（BPH）和性功能障碍是老年男性中高发性疾病。多项研究发现，对于50岁及以上的男性，BPH与因性功能减退导致的下尿路症状（LUTS）之间存在关联，经尿道前列腺切除术（TURP）被视为该病症的金标准治疗方案。TURP对性功能的影响仍不明确，术前性功能正常的患者在接受TURP后出现新发勃起功能障碍（ED）的潜在病理生理机制也不清楚，而逆行射精和射精量减少是BPH治疗产生的明确副作用。本研究旨在回顾性评估2008年至2012年期间在巴勒莫P.贾科内大学医院泌尿外科以及索菲亚 - 塞尔维洛别墅医院接受手术的患者中，经尿道前列腺切除术（TURP）对性功能的影响。次要目标是将样本数据与干预实践及国际标准重新关联。
本回顾性纵向研究针对287名可招募患者中的264名进行，这些患者年龄在50至85岁之间，患有BPH，并于2008年至2012年期间接受了TURP手术。通过电话访谈并使用国际勃起功能指数（IIEF）来评估性功能。要求纳入研究的患者首先描述手术前的性功能状况，随后报告治疗后的性功能状态，以便为每位患者获取一份TURP术前和术后问卷，从而进行符合实际情况的比较，避免对功能障碍现象的高估。
在TURP术前，94.32%的样本报告有性活动，其中41.3%的患者勃起功能良好，51.5%为轻度/中度ED，1.5%为完全性ED；62.9%的患者性欲良好，31.4%性欲缺乏，5.7%无性欲（后一组数据对应无性活动患者）；29.5%的患者对性生活满意，11.7%稍有不满，35.3%中度不满，23.5%不满或非常不满（其中17.8%有性活动，5.7%无性活动）。在TURP术后，89.4%的样本报告有性活动，其中39.1%的患者勃起功能良好，46.9%为轻度/中度DE，4%为完全性DE；53.8%的患者性欲良好，33.7%性欲缺乏，13.5%无性欲（包括1.9%有性活动和10.6%无性活动）；29.5%的患者对性生活满意，9.5%稍有不满，35.3%中度不满，17.8%不满或非常不满（其中14.8%有性活动，10.6%无性活动）。TURP术后有性活动的患者中，47.8%出现逆行射精（若考虑整个样本，则为42.8%）。
与射精功能相比，TURP对勃起功能没有负面影响。TURP术前勃起功能良好的109名患者中，5.8%报告术后勃起功能恶化。TURP术前轻度/中度ED的136名患者中，3.7%报告术后病情恶化，16.2%报告有所改善，而9.5%停止了任何性活动。3.7%的病例报告TURP术后出现完全性ED，而所有性功能恶化的患者均出现性欲和性满意度下降。TURP术后有性活动的患者中，48%出现逆行射精。术前和术后均需特别关注心理因素，其可能成为性活动下降的重要因素。
