Center for Men's Health, Glickmassn Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, United States.
Sex Med Rev. 2023 Sep 27;11(4):375-383. doi: 10.1093/sxmrev/qead002.
Clinicians primarily focus on the presence or absence of anterograde ejaculation following surgery for benign prostatic hyperplasia (BPH). Failing to assess dysfunctional ejaculation and associated bother in a granular fashion can underestimate the prevalence and significance of ejaculatory dysfunction in this population.
This scoping review provides critical appraisal of existing tools assessing ejaculatory function and associated bother, emphasizing the importance of adequate history-taking, preoperative counseling, and supplemental questions that should be used prior to and after treatment.
A literature review was conducted using pertinent keywords from 1946 to June 2022. Eligibility criteria included men developing ejaculatory dysfunction following BPH surgery. Measured outcomes included the assessment of patient bother related to ejaculatory function, pre- and postoperative scores from the Male Sexual Health Questionnaire (MSHQ). and Danish Prostate Symptom sexual function domain (DAN-PSSsex).
Results of this study included only 10 documented patients' bother due to ejaculatory dysfunction following treatment. Pre- and postoperative MSHQ were used as the diagnostic tool in 43/49 studies, one study documented "preservation of anterograde ejaculation", and one used DAN-PSSsex. Q1-4 of the MSHQ were used in 33/43 studies, 3/43 used Q1, 3, 5-7, 1/43 used solely Q4, 1/43 used Q1-3 + Q6 and Q7, and 5/43 used the entire MSHQ. No studies used post-ejaculation urinalysis to diagnose retrograde ejaculation. Only four studies explicitly documented bother and found 25-35% of patients were bothered with a "lack of ejaculate" or "other ejaculation difficulties" during sexual activity after BPH surgery.
There are currently no studies stratifying patient bother by various components of ejaculation (force, volume, consistency, sensation of seminal expulsion, painful ejaculation, etc.) after BPH surgery. Opportunities for improvement exist in reporting ejaculatory dysfunction related to BPH treatment. A comprehensive sexual health history is needed. Further investigation into effects of BPH surgical treatments on specific characteristics of the patient's experience of ejaculation is required.
临床医生主要关注良性前列腺增生 (BPH) 手术后是否存在顺行性射精。如果不以颗粒状方式评估性功能障碍性射精和相关烦恼，可能会低估该人群中射精功能障碍的发生率和重要性。
本范围综述对评估射精功能和相关烦恼的现有工具进行了批判性评估，强调在治疗前后应进行充分的病史采集、术前咨询以及使用补充问题的重要性。
使用 1946 年至 2022 年 6 月的相关关键词进行文献回顾。纳入标准包括 BPH 手术后出现射精功能障碍的男性。评估指标包括与射精功能相关的患者烦恼程度、男性性健康问卷 (MSHQ) 的术前和术后评分以及丹麦前列腺症状性功能域 (DAN-PSSsex)。
本研究结果仅包括 10 例因治疗后射精功能障碍而感到烦恼的患者。43/49 项研究使用术前和术后 MSHQ 作为诊断工具，1 项研究记录了“顺行性射精的保留”，1 项研究使用了 DAN-PSSsex。33/43 项研究使用了 MSHQ 的 Q1-4，3/43 项研究使用了 Q1、3、5-7，1/43 项研究仅使用了 Q4，1/43 项研究使用了 Q1-3+Q6 和 Q7，5/43 项研究使用了整个 MSHQ。没有研究使用射精后尿分析来诊断逆行射精。只有 4 项研究明确记录了烦恼，并发现 25-35%的患者在 BPH 手术后的性行为中因“缺乏精液”或“其他射精困难”而感到烦恼。
目前尚无研究对 BPH 手术后患者因各种射精成分（力度、量、稠度、精液射出感、射精疼痛等）而产生的烦恼进行分层。在报告与 BPH 治疗相关的射精功能障碍方面，存在改进的机会。需要进行全面的性健康史评估。需要进一步研究 BPH 手术治疗对患者射精体验特定特征的影响。
