Roehrborn Claus G, Rukstalis Daniel B
UT Southwestern Medical Center, Dallas, TX, USA.
Prisma Health USC Medical Group, Division of Urology; 300 Palmetto Health Pkwy, Columbia, SC 29212.
Eur Urol Focus. 2022 Jan;8(1):217-227. doi: 10.1016/j.euf.2020.12.013. Epub 2021 Jan 9.
Sexual dysfunction is a common side effect of medical therapy for benign prostatic hyperplasia (BPH), whereas prostatic urethral lift (PUL) offers safe and effective relief of lower urinary tract symptoms while preserving sexual function.
To compare the long-term impact on sexual health of PUL or daily medical therapy of doxazosin or finasteride alone or in combination in BPH patients.
DESIGN, SETTING, AND PARTICIPANTS: This was a comparative analysis of sexual function outcomes from PUL studies (L.I.F.T. [n=107], Crossover [n=42], and MedLift [n=39]) and the Medical Therapy of Prostatic Symptoms (MTOPS) trial. The men included were sexually active with International Prostate Symptom Score ≥13, Qmax ≤12ml/s, and prostate volume 30-80 cm. MTOPS subjects completed the Brief Male Sexual Function Inventory, while PUL subjects completed the International Index of Erectile Function and the Male Sexual Health Questionnaire for Ejaculatory Function.
Mean percentage changes from baseline in erectile, ejaculatory, and sexual satisfaction domains were compared at 12, 24, 36, and 48 mo.
PUL significantly improved erectile function through 24 mo, and ejaculatory function and sexual satisfaction across all time points. Medical therapy did not improve sexual function at any time point. Finasteride significantly decreased erectile function at 48 mo, and combined therapy significantly reduced ejaculatory function at 12 and 24 mo. Comparatively, PUL was superior to finasteride in preserving erectile function at 24 and 48 mo, and superior to doxazosin and combined therapy at 12 mo. PUL outperformed all three medical therapies at all time points in improving ejaculatory function and sexual satisfaction. Limitations include the use of distinct patient-reported questionnaires and narrowed data on comorbidities that influence male sexual function.
Indirect comparison reveals that PUL is superior to BPH medical therapy in preserving erectile and ejaculatory function and sexual satisfaction.
In our non-head-to-head study, only patients undergoing PUL for an enlarged prostate experienced improvements in sexual health. Conversely, patients on medical therapy experienced worsening of erectile and ejaculatory function.
性功能障碍是良性前列腺增生（BPH）医学治疗的常见副作用，而前列腺尿道悬吊术（PUL）在保留性功能的同时能安全有效地缓解下尿路症状。
比较PUL或多沙唑嗪或非那雄胺单独或联合每日药物治疗对BPH患者性健康的长期影响。
设计、设置和参与者：这是一项对PUL研究（L.I.F.T. [n = 107]、交叉试验 [n = 42] 和MedLift [n = 39]）以及前列腺症状医学治疗（MTOPS）试验中性功能结果的比较分析。纳入的男性有性活动，国际前列腺症状评分≥13，最大尿流率≤12ml/s，前列腺体积30 - 80 cm³。MTOPS受试者完成简短男性性功能量表，而PUL受试者完成勃起功能国际指数和射精功能男性性健康问卷。
比较在12、24、36和48个月时勃起、射精和性满意度领域相对于基线的平均百分比变化。
PUL在24个月内显著改善勃起功能，在所有时间点均显著改善射精功能和性满意度。药物治疗在任何时间点均未改善性功能。非那雄胺在48个月时显著降低勃起功能，联合治疗在12和24个月时显著降低射精功能。相比之下，PUL在24和48个月时在保留勃起功能方面优于非那雄胺，在12个月时优于多沙唑嗪和联合治疗。在改善射精功能和性满意度方面，PUL在所有时间点均优于所有三种药物治疗。局限性包括使用不同的患者报告问卷以及关于影响男性性功能的合并症的数据有限。
间接比较表明，PUL在保留勃起和射精功能以及性满意度方面优于BPH药物治疗。
在我们的非头对头研究中，只有接受PUL治疗前列腺增生的患者性健康得到改善。相反，接受药物治疗的患者勃起和射精功能恶化。
