Manfredi Celeste, García-Gómez Borja, Arcaniolo Davide, García-Rojo Esther, Crocerossa Fabio, Autorino Riccardo, Gratzke Christian, De Sio Marco, Romero-Otero Javier
Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.
Department of Urology, Hospital Universitario 12 Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain; ROC Clinic, Madrid, Spain.
Eur Urol Focus. 2022 Nov;8(6):1711-1732. doi: 10.1016/j.euf.2022.06.007. Epub 2022 Jul 6.
Several sexual side effects, including erectile, ejaculatory, and orgasmic dysfunction, were reported with the majority of surgical procedures for benign prostatic obstruction (BPO).
To systematically review current evidence regarding the impact of benign prostatic hyperplasia (BPH) surgery on sexual function.
A comprehensive bibliographic search on the MEDLINE, Cochrane Library, Embase, Web of Science, and Google Scholar databases was conducted in July 2021. The population, intervention, comparator, and outcome (PICO) model was used to define study eligibility. Studies were Included if they assessed patients with BPO and related lower urinary tract symptoms (P) undergoing BPH surgery (I) with or without a comparison between surgical treatments (C) evaluating the impact on sexual function (O). Retrospective and prospective primary studies were included. A pooled analysis was conducted on studies including the postoperative assessment of International Index of Erectile Function (IIEF)-5, Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD; Function and/or Bother), or retrograde ejaculation (RE) rate (PROSPERO database ID: CRD42020177907).
A total of 151 studies investigating 20 531 patients were included. Forty-eight randomized controlled trials evaluating 5045 individuals were eligible for the meta-analysis. In most studies (122, 80.8%), only erectile and/or ejaculatory function was evaluated. A substantial number of articles (67, 44.4%) also used nonvalidated tools to evaluate erectile and/or ejaculatory function. The pooled analysis showed no statistically significant changes in IIEF-5 score compared with baseline for the transurethral resection of the prostate (TURP; weighted mean difference [WMD] 0.76 pts; 95% confidence interval [CI] -0.1, 1.62; p = 0.08), laser procedure (WMD 0.33 pts; 95% CI -0.1, 0.77; p = 0.13), and minimally invasive treatment (WMD -1.37 pts; 95% CI -3.19, 0.44; p = 0.14) groups. A statistically significantly higher rate of RE was found after TURP (risk ratio [RR] 13.31; 95% CI 8.37, 21.17; p < 0.00001), other electrosurgical procedures (RR 34.77; 95% CI 10.58, 127.82; p < 0.00001), and the entire laser group (RR 17.37; 95% CI 5.93, 50.81; p < 0.00001). No statistically significant increase in RE rate was described after most of the minimally invasive procedures (p > 0.05). The pooled analysis of MSHQ-EjD scores was possible only for prostatic urethral lift, showing no statistically significant difference between baseline and post-treatment MSHQ-EjD Function scores (WMD -0.80 pts; 95% CI -2.41, 0.81; p = 0.33), but postoperative MSHQ-EjD Bother scores were significantly higher (WMD 0.76 pts; 95% CI 0.22, 1.30; p = 0.006).
Erectile function appears to be unaffected by most surgical procedures for BPO. RE is a very common adverse event of BPH surgery, although emerging minimally invasive surgical procedures could be associated with a lower risk.
Benign prostatic hyperplasia surgery can have an impact on sexual function, mainly involving ejaculatory function.
据报道，大多数治疗良性前列腺梗阻（BPO）的外科手术会产生多种性副作用，包括勃起、射精及性高潮功能障碍。
系统回顾有关良性前列腺增生（BPH）手术对性功能影响的现有证据。
2021年7月，我们在MEDLINE、Cochrane图书馆、Embase、科学网和谷歌学术数据库中进行了全面的文献检索。采用人群、干预措施、对照和结局（PICO）模型来确定研究的纳入标准。纳入的研究需评估患有BPO及相关下尿路症状的患者（P）接受BPH手术（I），无论是否有手术治疗之间的比较（C），同时评估对性功能的影响（O）。纳入回顾性和前瞻性的原始研究。对包括国际勃起功能指数（IIEF）-5、男性性健康问卷-射精功能障碍（MSHQ-EjD；功能和/或困扰）术后评估或逆行射精（RE）率的研究进行汇总分析（PROSPERO数据库标识符：CRD42020177907）。
共纳入151项研究，涉及20531例患者。48项评估5045例个体的随机对照试验符合荟萃分析的条件。在大多数研究（122项，80.8%）中，仅评估了勃起和/或射精功能。大量文章（67项，44.4%）还使用了未经验证的工具来评估勃起和/或射精功能。汇总分析显示，与基线相比，经尿道前列腺切除术（TURP）组的IIEF-5评分无统计学显著变化（加权平均差[WMD]0.76分；95%置信区间[CI]-0.1，1.62；p=0.08），激光手术组（WMD 0.33分；95%CI-0.1，0.77；p=0.13），以及微创治疗组（WMD-1.37分；95%CI-3.19，0.44；p=0.14）。TURP术后发现RE发生率有统计学显著升高（风险比[RR]13.31；95%CI 8.37，21.17；p<0.00001），其他电外科手术（RR 34.77；95%CI 10.58，127.82；p<0.00001），以及整个激光手术组（RR 17.37；95%CI 5.93，50.81；p<0.00001）。大多数微创术后RE发生率无统计学显著升高（p>0.05）。仅对前列腺尿道悬吊术进行了MSHQ-EjD评分的汇总分析，结果显示治疗前后MSHQ-EjD功能评分无统计学显著差异（WMD-0.80分；95%CI-2.41,0.81；p=0.33），但术后MSHQ-EjD困扰评分显著更高（WMD 0.76分；95%CI 0.22，1.30；p=0.006）。
大多数BPO手术似乎不会影响勃起功能。RE是BPH手术非常常见的不良事件，尽管新兴的微创手术可能与之相关的风险较低。
良性前列腺增生手术可能会对性功能产生影响，主要涉及射精功能。
