Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China.
Department of Library, Shengjing Hospital of China Medical University, Shenyang, China.
J Sex Med. 2020 Nov;17(11):2181-2190. doi: 10.1016/j.jsxm.2020.06.001. Epub 2020 Jul 19.
Currently, no study has focused on the postoperative erectile function in patients with benign prostatic hyperplasia (BPH) by comparing Hiraoka's transurethral detachment of prostate (TUDP) and transurethral resection of prostate (TURP).
To compare the effects of Hiraoka's TUDP and TURP on postoperative erectile function in patients with BPH after long-term follow-up.
A total of 104 consecutive patients with BPH treated in our hospital between September 2018 and February 2019 were included in the study. All patients who met the inclusion criteria were randomly divided into the Hiraoka's TUDP (n = 52) and TURP (n = 52) groups. Patient baseline data were collected. The international index of erectile function (IIEF-5), minimal clinically important difference (MCID), and quality of life scale (QOLS) were used to evaluate erectile function and quality of life 3, 6, and 12 months after surgery. Primary study endpoints were IIEF-5 and MCID. Secondary study endpoints were QOLS and independent prognostic factors for MCID.
Hiraoka's TUDP experienced greater improvement in postoperative IIEF5 scores than patients who underwent TURP.
Patients in the Hiraoka's TUDP group had significantly higher mean IIEF-5 scores than those in the TURP group 6 and 12 months after surgery (6 months: 18.9 vs 14.8, P < .001; 12 months: 18.1 vs 15.7, P < .001). The percentages of patients in the TUDP group who achieved an MCID were 88.5% and 80.8%, compared to 30.8% and 46.2% in the TURP group (P < .001 for both), 6 and 12 months after the operation, respectively. Patients in the TUDP group had lower QOLS scores than those in the TURP group after the surgery. The surgical method was an independent prognostic factor for MCID (odds ratio = 0.218).
Until now, no study has focused on the postoperative erectile function in patients with BPH by comparing Hiraoka's TUDP and TURP. Our study addressed this issue, which can add a new paradigm in the management to BPH.
STRENGTH & LIMITATIONS: The comparison between Hiraoka's TUDP and TURP using a statistically appropriate, adequately powered methodology is the strength of the study. The single center and less participants are the limitations of the study. We believe that multicenter and large-sample studies are needed to further verify these study conclusions.
Among similar cohorts of patients with BPH who underwent TUDP and TURP, patients who underwent Hiraoka's TUDP experienced greater improvement in postoperative IIEF5 scores than patients who underwent TURP, while improvement in IPSS was similar among both groups. Pan C, Zhan Y, Zhao Y, et al. Comparison of Hiraoka's Transurethral Detachment Prostatectomy and Transurethral Resection of the Prostate Effects on Postoperative Erectile Function in Patients With Benign Prostatic Hyperplasia: A Prospective Randomized Controlled Study. J Sex Med 2020;17:2181-2190.
目前，尚无研究通过比较 Hiraoka 经尿道前列腺切除术（TUDP）和经尿道前列腺切除术（TURP）来关注良性前列腺增生（BPH）患者的术后勃起功能。
长期随访比较 Hiraoka 的 TUDP 和 TURP 对 BPH 患者术后勃起功能的影响。
纳入 2018 年 9 月至 2019 年 2 月在我院治疗的 104 例连续 BPH 患者，所有符合纳入标准的患者均随机分为 Hiraoka 的 TUDP（n=52）和 TURP（n=52）组。收集患者的基线数据。使用国际勃起功能指数（IIEF-5）、最小临床重要差异（MCID）和生活质量量表（QOLS）评估术后 3、6 和 12 个月的勃起功能和生活质量。主要研究终点为 IIEF-5 和 MCID。次要研究终点为 QOLS 和 MCID 的独立预测因素。
与 TURP 组相比，Hiraoka 的 TUDP 组患者术后 IIEF5 评分改善更明显。
Hiraoka 的 TUDP 组患者术后 6 个月和 12 个月的平均 IIEF-5 评分均明显高于 TURP 组（6 个月：18.9 比 14.8，P<0.001；12 个月：18.1 比 15.7，P<0.001）。TUDP 组术后达到 MCID 的患者比例分别为 88.5%和 80.8%，而 TURP 组分别为 30.8%和 46.2%（均 P<0.001），分别为术后 6 个月和 12 个月。TUDP 组患者术后 QOLS 评分低于 TURP 组。手术方法是 MCID 的独立预测因素（比值比=0.218）。
到目前为止，尚无研究通过比较 Hiraoka 的 TUDP 和 TURP 来关注 BPH 患者的术后勃起功能。我们的研究解决了这个问题，可以为 BPH 的治疗提供一个新的范例。
该研究的优势在于采用了统计学上适当、充分有力的方法比较了 Hiraoka 的 TUDP 和 TURP。该研究的局限性在于单中心和参与者较少。我们认为，需要进行多中心和大样本研究来进一步验证这些研究结论。
