Эректильная функция после эндоскопических операций по удалению гиперплазии предстательной железы

Статья в Elpub

Андрология и генитальная хирургия. 2017; 18: 12-18

Эректильная функция после эндоскопических операций по удалению гиперплазии предстательной железы

Глыбочко П. В., Аляев Ю. Г., Рапопорт Л. М., Еникеев Д. В., Ахвледиани Н. Д., Спивак Л. Г., Чернов Я. Н., Лаухтина Е. А., Дымова А. В., Тараткин М. С.

https://doi.org/10.17650/2070-9781-2017-18-4-12-18

Аннотация

Введение. Доброкачественная гиперплазия предстательной железы (ДГПЖ) на сегодняшний день встречается у 50 % мужчин старше 50 лет и у 80 % – старше 80 лет. Наиболее эффективный метод лечения ДГПЖ –хирургическое удаление аденомы предстательной железы (ПЖ). Он позволяет быстро снять инфравезикальную обструкцию мочевых путей, но при этом повышается вероятность развития эректильной дисфункции, одного из наиболее значимых возможных осложнений. В работе освещено влияние на эректильную функцию (ЭФ) методов эндоскопического удаления ДГПЖ: моно- и биполярной трансуретральной резекции (ТУР) ПЖ, гольмиевой (HoLEP) и тулиевой (ThuLEP) лазерных энуклеаций, вапоризации ПЖ. Представлены эволюция современных лазерных технологий и изменение в связи с этим подхода к сохранению ЭФ при лечении аденомы ПЖ.

Цель настоящей работы – обсуждение возможных механизмов нарушения ЭФ после эндоскопических операций по удалению ДГПЖ, а также выяснение, какой из механизмов и почему является наиболее вероятной причиной возникновения послеоперационной эректильной дисфункции.

Вывод. По имеющимся данным такие методики, как биполярная ТУР ПЖ, HoLEP и ThuLEP, не оказывают на эрекцию существенного отрицательного влияния. Более того, в некоторых случаях процесс ее восстановления занимает существенно меньше времени при использовании ThuLEP, поэтому проведение последней следует рекомендовать пациентам, заинтересованным в скором восстановлении ЭФ.

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Andrology and Genital Surgery. 2017; 18: 12-18

Erectile function after endoscopic surgery for prostatic hyperplasia removal

Glybochko P. V., Alyaev Yu. G., Rapoport L. M., Enikeev D. V., Akhvlediani N. D., Spivak L. G., Chernov Ya. N., Laukhtina E. A., Dymova A. V., Taratkin M. S.

https://doi.org/10.17650/2070-9781-2017-18-4-12-18

Abstract

Introduction. Currently, benign prostatic hyperplasia (BPH) is diagnosed in 50 % of men aged 50 and older and in 80 % of men aged 80 and older. The most effective treatment method is surgical removal of prostate adenoma. It allows to quickly remove infravesical urinary tract obstruction, but at the same time it increases the risk of erectile dysfunction, one of the most important possible complications. The rate of this complication was significantly decreased by implementation of modern laser technology in urological practice.

The study considers the effect of different methods of endoscopic removal of BPH on erectile function (EF): mono- and bipolar transurethral resection (TUR) of the prostate, holmium (HoLEP) and thulium (ThuLEP) laser enucleation, prostate vaporization. Evolution of modern laser technologies and changes in approaches to preservation of EF in treatment of prostate adenoma are presented. The study objective is to discuss possible mechanisms of EF disorders after endoscopic surgeries for BPH removal, as well as to identify which of the mechanisms is the most probable cause of postoperative erectile dysfunction.

Conclusion. According to the available data, such methods as bipolar TUR of the prostate, HoLEP, and ThuLEP do not negatively affect erection in any significant way. Moreover, in some cases its recovery is significantly quicker after ThuLEP; therefore, the last method is recommended for patients interested in quick EF recovery.

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