Department of Urology, Hamamatsu University School of Medicine, Shizuoka, Japan
Department of Urology, Hamamatsu University School of Medicine, Shizuoka, Japan.
In Vivo. 2022 Nov-Dec;36(6):2960-2964. doi: 10.21873/invivo.13039.
BACKGROUND/AIM: Sexual function in patients with benign prostatic hyperplasia (BPH) could be affected by surgical intervention, such as holmium laser enucleation of the prostate (HoLEP). The objective of the present study was to investigate whether changes in erectile function (EF) after HoLEP affect postoperative outcomes in patients with BPH.
We retrospectively reviewed 54 consecutive Japanese patients with BPH undergoing HoLEP at our institution between August 2017 and December 2020, and analyzed data obtained before and 6 months after HoLEP, including the Erection Hardness Score (EHS), International Prostate Symptom Score (IPSS), IPSS-Quality of Life (IPSS-QOL), Overactive Bladder Symptom Score (OABSS), and the Medical Outcomes Study 8-Item Short-Form Health Survey consisting of a mental health component summary (MCS) and physical health component summary (PCS).
Although no significant differences were observed between preoperative and postoperative EHS, postoperative EHS deteriorated in 19 out of 54 patients. Total IPSS, IPSS-QOL, and OABSS significantly improved after HoLEP, irrespective of the deterioration of EHS; however, despite the lack of significant changes in MCS and PCS in 19 patients with deteriorated EHS, significant improvements in MCS, but not PCS, were postoperatively observed in the remaining 35. A multivariable analysis of several factors identified a preoperative estimated prostate volume >100 cm as an independent risk factor associated with the postoperative deterioration of EHS.
HoLEP had limited impact on postoperative EF in BPH patients; however, favorable QOL may be expected in patients without the postoperative deterioration of EF. Accordingly, it may be important to consider the prostate volume and its effect on postoperative EF when selecting indications for HoLEP.
背景/目的：手术干预，如钬激光前列腺剜除术（HoLEP），可能会影响良性前列腺增生（BPH）患者的性功能。本研究旨在探讨 HoLEP 后勃起功能（EF）的变化是否会影响 BPH 患者的术后结局。
我们回顾性分析了 2017 年 8 月至 2020 年 12 月期间在我院接受 HoLEP 的 54 例连续日本 BPH 患者的数据，并分析了 HoLEP 前后 6 个月的数据，包括勃起硬度评分（EHS）、国际前列腺症状评分（IPSS）、IPSS 生活质量评分（IPSS-QOL）、膀胱过度活动症症状评分（OABSS）以及包含心理健康成分综合评分（MCS）和身体健康成分综合评分（PCS）的健康调查 8 项简短量表。
尽管术前和术后 EHS 之间无显著差异，但 54 例患者中有 19 例术后 EHS 恶化。HoLEP 后总 IPSS、IPSS-QOL 和 OABSS 显著改善，与 EHS 恶化无关；然而，在 19 例 EHS 恶化的患者中，MCS 和 PCS 虽无显著变化，但在其余 35 例患者中，术后 MCS 显著改善，而 PCS 无显著变化。对多个因素的多变量分析发现，术前前列腺体积>100 cm3 是与术后 EHS 恶化相关的独立危险因素。
HoLEP 对 BPH 患者术后 EF 的影响有限；然而，对于 EF 术后无恶化的患者，可能会预期 QOL 得到改善。因此，在选择 HoLEP 的适应证时，考虑前列腺体积及其对术后 EF 的影响可能很重要。
