Gild Philipp, Dahlem Roland, Pompe Raisa S, Soave Armin, Vetterlein Malte W, Ludwig Tim A, Maurer Valentin, Marks Phillip, Ahyai Sascha A, Chun Felix K-H, Lenke Lukas, Ernst Tabea, Fisch Margit, Rink Michael, Meyer Christian P, Becker Andreas
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Urology, University Medical Center Goettingen, Goettingen, Germany.
Andrology. 2020 Nov;8(6):1779-1786. doi: 10.1111/andr.12887. Epub 2020 Aug 31.
A vast body of literature has focused on erectile function after Holmium Laser Enucleation of the Prostate (HoLEP). Interestingly, retrograde ejaculation (RE), despite its frequency has sparsely been investigated.
To study patient perception and impact of RE on sexuality following HoLEP.
We retrospectively analyzed 2,131 patients undergoing HoLEP 2006-2015 at our institution. Patients were followed via standardized questionnaires namely International Index of Erectile Function (IIEF) as well as Male Sexual Health Questionnaire Ejaculatory Short Form (MSHQ-EjD-SF). Exclusion criteria were missing/follow-up <6 months, missing data on MSHQ-EjD-SF and IIEF score, resulting in 535 assessable patients. Multivariable logistic regression was employed to identify independent predictors of satisfaction with overall sex life (IIEF question 13).
Median follow-up was 50 months (IQR: 30-78). Overall, 495 (92.5%) patients reported RE. Patients differed significantly with respect to age (P = .036), IPSS at follow-up (P = .01), and erectile function (P < .001), whereas no other statistically significant differences were observed. In multivariable logistic regression analyses, presence of RE was not independently associated with satisfaction with overall sex life (OR: 2.7, 95% CI: 0.70-10.5, P = .1). However, in the cohort of patients exhibiting RE, patients who stated "feeling bothered by RE" had lower satisfaction with overall sex life (OR: 0.23, 95% CI: 0.13-0.38, P < .001). Bother by RE varied according to erectile function and did not impact overall satisfaction in men with superior erectile function.
RE is a very common event after HoLEP but in this retrospective analysis was not associated with overall satisfaction with sex life. Contrary, satisfaction with sex life is impaired in patients who feel bothered by RE. Proper patient selection will pose key to identify patients in which RE bother will offset the benefits of LUTS relief.
大量文献聚焦于前列腺钬激光剜除术（HoLEP）后的勃起功能。有趣的是，逆行射精（RE）尽管发生率较高，但却很少被研究。
研究HoLEP术后患者对逆行射精的认知及其对性功能的影响。
我们回顾性分析了2006年至2015年在我院接受HoLEP手术的2131例患者。通过标准化问卷对患者进行随访，即国际勃起功能指数（IIEF）以及男性性健康问卷射精简表（MSHQ-EjD-SF）。排除标准为失访/随访时间<6个月、MSHQ-EjD-SF和IIEF评分数据缺失，最终得到535例可评估患者。采用多变量逻辑回归分析确定总体性生活满意度（IIEF第13题）的独立预测因素。
中位随访时间为50个月（四分位间距：30 - 78个月）。总体而言，495例（92.5%）患者报告有逆行射精。患者在年龄（P = 0.036）、随访时的国际前列腺症状评分（IPSS）（P = 0.01）和勃起功能（P < 0.001）方面存在显著差异，而未观察到其他具有统计学意义的差异。在多变量逻辑回归分析中，逆行射精的存在与总体性生活满意度无独立相关性（比值比：2.7，9... 展开 （此处原文95% CI: 0.70 - 10.5中间部分缺失，根据前文推测补充完整）95%置信区间：0.70 - 10.5，P = 0.1）。然而，在出现逆行射精的患者队列中，称“因逆行射精感到困扰”的患者对总体性生活的满意度较低（比值比：0.23，95%置信区间：0.13 - 0.38，P < 0.001）。逆行射精造成的困扰因勃起功能而异，对勃起功能较好的男性的总体满意度没有影响。
逆行射精是HoLEP术后非常常见的情况，但在这项回顾性分析中，它与总体性生活满意度无关。相反，因逆行射精感到困扰的患者性生活满意度受损。正确选择患者将是确定逆行射精困扰会抵消下尿路症状缓解益处的患者的关键。
