“五步法”经尿道钬激光前列腺剜除术对大体积前列腺增生患者术后尿控及性功能保护的影响

doi:10.3969/j.issn.1006-7795.2025.02.012

首都医科大学学报 ›› 2025, Vol. 46 ›› Issue (2): 263-268.doi: 10.3969/j.issn.1006-7795.2025.02.012

• 前列腺疾病诊疗技术与进展 • 上一篇下一篇

“五步法”经尿道钬激光前列腺剜除术对大体积前列腺增生患者术后尿控及性功能保护的影响

闻竹^1,2，张超¹，张贤生^2*

1.合肥市第一人民医院泌尿外科，合肥 230000；2.安徽医科大学第一附属医院泌尿外科，合肥 230022

收稿日期:2024-11-15 出版日期:2025-04-21 发布日期:2025-04-14
通讯作者: 张贤生 E-mail:xiansheng-zhang@163.com
基金资助:
国家自然科学基金面上项目（82071637）。

Effect of the “five-step” method holmium laser enucleation for benign prostatic hyperplasia with large volume on urinary control and sexual protection

Wen Zhu^{1, 2}, Zhang Chao¹, Zhang Xiansheng^2*

1. Department of Urology, the First People's Hospital of Hefei，Hefei 230000, China；2 Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China

Received:2024-11-15 Online:2025-04-21 Published:2025-04-14
Supported by:
This study was supported by National Natural Science Foundation of China（82071637）。

摘要/Abstract

摘要： 目的观察并探讨“五步法”经尿道钬激光前列腺剜除术（ Holmium laser enucleation of prostate，HoLEP）处理大体积前列腺增生对尿控及性功能保护的影响。方法回顾性分析自2021年6月至2024年5月合肥市第一人民医院收治的105例大体积前列腺增生患者的资料,其中52例行“五步法”HoLEP术治疗；53例以双极等离子前列腺剜除术（transurethral plasma kinetic enucleation of the prostate，TUKEP）治疗。收集患者围手术期相关指标，并观察两组患者术后尿失禁发生率及性功能改变情况［逆行射精发生率及国际勃起功能指数-5 (International Index of Erectile Function-5，IIEF-5)评分］，比较两组患者术前与术后6个月最大尿流率（maximum flow rate，Qmax）、国际前列腺症状评分（International Prostate Symptom Score，IPSS）、生活质量评分（quality of life，QOL）、前列腺特异性抗原（prostate specific antigen，PSA）等指标变化情况。结果两组患者围手术期留置尿管时间、切除腺体质量的比较差异均无统计学意义；HoLEP组血红蛋白下降值、手术时间均少于TUKEP组（P＜0.05）。两组患者术后5 d血清C反应蛋白均高于术前（P＜0.05），但HoLEP组低于TUKEP组（P＜0.05）。所有患者术后随访6个月，两组间Qmax、PSA、IPSS、QOL及IIEF-5差异均无统计学意义；短暂性尿失禁、逆行射精发生率比较，HoLEP组明显优于TUKEP组（P＜0.05）。结论 “五步法”HoLEP术式治疗大体积前列腺增生手术疗效良好，具有术后并发症少、恢复快等优点。在达到同样疗效的情况下，对尿控及性功能保护较好，值得推广。

关键词: 良性前列腺增生, 剜除术, 钬激光, 手术技巧, 疗效

Abstract: Objective To analyze the effects of “five-step” Holmium laser enucleation on urinary continence and sexual function of the patients with the large volume prostate. Methods Data of 105 patients with massive prostatic hyperplasia admitted to the First People's Hospital of Hefei from June 2021 to May 2024 were retrospectively analyzed. Among them,52 patients were treated with the five-step Holmium laser enucleation of prostate (HoLEP),and the others were treated with transurethral plasma kinetic enucleation of the prostate(TUKEP). The perioperative data were collected, and the incidence of urinary incontinence and the changes of sexual function　［incidence of retrograde ejaculation and international index of erectile function-5 (IIEF-5) score］ were observed in the two groups.The changes of maximum urine flow rate (Qmax), international prostate symptom score (IPSS), quality of life (QOL) score, prostate specific antigen (PSA) were compared between the two groups before and 6 months after surgery.Results There were no significant differences in indwelling catheterization time and weight of resected glands(P>0.05).The postoperative hemoglobin decline, the average operation time in the HoLEP group was significantly reduced than that in the TUKEP group(P<0.05). The index of C-reactive protein after surgery in the two groups was higher than before surgery (P< 0.05), but HoLEP group was better than that of TUKEP group (P< 0.05). After 6 months, there were no significant differences in PSA, Qmax, IPSS, QOL and IIEF-5 between the two groups (P> 0.05).The incidence of transient urinary incontinence and retrograde ejaculation in the HoLEP group was significantly better than that in the TUKEP group (P< 0.05).Conclusion The “five-step” HoLEP method is effective in the treatment for large benign prostatic hyperplasia with large volume. Compared with TUKEP group, HoLEP showed the same treatment efficacy, the less impact on urinary control and retrograde ejaculation, and the more improved postoperative QOL.The “five-step” HoLEP is feasible and safe with promising clinical application prospects.

Key words: benign prostatic hyperplasia, enucleation of the prostate, Holmium laser, surgical technique, efficacy

中图分类号:

R697+.3

闻竹, 张超, 张贤生. “五步法”经尿道钬激光前列腺剜除术对大体积前列腺增生患者术后尿控及性功能保护的影响[J]. 首都医科大学学报, 2025, 46(2): 263-268.

Wen Zhu, , Zhang Chao, Zhang Xiansheng. Effect of the “five-step” method holmium laser enucleation for benign prostatic hyperplasia with large volume on urinary control and sexual protection[J]. Journal of Capital Medical University, 2025, 46(2): 263-268.

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“五步法”经尿道钬激光前列腺剜除术对大体积前列腺增生患者术后尿控及性功能保护的影响

Effect of the “five-step” method holmium laser enucleation for benign prostatic hyperplasia with large volume on urinary control and sexual protection

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