【摘要】 目的 探讨在耻骨后前列腺癌根治术中尿控功能和性功能保护的手术技巧和疗效。 方法 2001年8月-2010年1月，行耻骨后前列腺癌根治术21例，其中2例经腹腔镜。所有患者均早期控制缝扎背静脉复合体，并妥善处理前列腺尖和尿道。21例通过保护控尿神经、尿道横纹括约肌，保护了尿控功能；17例通过保留神经血管束技术（12例保留双侧，5例保留一侧）保护性功能。 结果 手术均成功完成，无围手术期严重并发症。2周拔出尿管后，排尿通畅，无尿道狭窄。术后3、12个月内恢复尿控能力患者分别为6、13例，持续性轻-中度尿失禁2例。21例患者中，术前勃起功能正常；术中保留神经血管束17例，术后3、12个月内勃起功能恢复分别为2、8例，4例勃起功能减弱，3例不能勃起。术后病理报告均为前列腺癌，未侵及精囊、膀胱颈、双侧淋巴结阴性。后尿道切缘阳性1例。术后6、24、54个月各有1例出现生化复发。 结论 手术精细解剖并注意技巧，可有效保护尿控功能和性功能，并达到肿瘤根治的疗效。【Abstract】 Objective To evaluate the surgical technique for the protection of urinary continence and erectile function in radical prostatectomy for prostate cancer and observe its clinical efficacy. Methods Twenty-one patients with prostate cancer had undergone radical prostatectomy during August 2001 to January 2010, in which two patients were operated through extraperitoneal laparoscope. Dorsal vein complex was sewed and ligated at early stage of surgery and prostate apex along with urethra were appropriately handled in all patients. By a serial measures consisting of protection for continence nerve and striated urethral sphincter, the function of urinary continence was managed to be spared in twenty-one patients, erectile function was managed to be spared through reservation of neurovascular bundle in seventeen patients (Bilateral neurovascular bundles were reserved in twelve patients, unilateral neurovascular bundle was reserved in five patients). Results All surgeries were successful without severe perioperative complications. The catheters were removed fourteen days after surgery in all patients, and it was observed that micturition was fluent in twenty-one patients. Functional recovery of urinary continence occurred within three months after surgery in six patients and twleve months in thirteen patients, continuous mild-moderate incontinece occurred in two patients. Erectile function was normal before surgery and neurovascular bundle was reserved during surgery in seventeen patients. The recovery of erectile function occurred within three months after surgery in two patients and twelve months in eight patients, erectile function was impaired in four patients, erectile dysfunction occurred in three patients, pathological diagnosis indicated prostate adenocarcinoma in all cases, while seminal vesicle and bladder neck were not invaded and bilateral pelvic lymph nodes were not metastasized, moreover, the pathological diagnosis of resected edge of posterior urethra was positive in one patient. One patient of bio-chemical recurrence occurred respectively within six months, twenty-four months and fifty-four months after surgery. Conclusion During radical prostatectomy for prostate cancer, delicately anatomizing and appropriate surgical technique could effectively protect erectile function and urinary continence and consequently achieve radical resection of tumor at the same time.
ObjectiveTo investigate the effect of pelvic autonomic nerve preservation (PANP) with total mesorectal excision (TME) on sexual and urinary function in male rectal cancer patients. MethodsClinical data of eightyfour patients with rectal cancer from January 2008 to October 2010 in our hospital were analyzed. According to different operative techniques, all the patients were divided into two groups: PANP+TME group (n=41) and TME group (n=43). The sexual dysfunction, urination disorder rate, and local recurrence rate after operation of patients between two groups were compared. ResultsErectile dysfunction rate of patients in TME+PANP group and TME group was 29.3% (12/41) and 76.7% (33/43), ejaculation disorder rate was 26.8% (11/41) and 79.1% (34/43), and urination dysfunction rate was 24.4% (10/41) and 79.1% (34/43), respectively. The rate of sexual and urinary dysfunction of patients in TME+PANP group was significantly lower than that in TME group (Plt;0.05). Local recurrence rate of patients in TME+PANP group (9.8%, 4/41) was similar to that in TME group (11.6%, 5/43)， Pgt;0.05. ConclusionPANP based on TME can reduce effectively the rate of sexual and urinary dysfunction in male rectal cancer patients, which does not increase the local recurrence rate after operation.
目的 探讨腹腔镜全直肠系膜切除术盆腔自主神经保留的可行性及对术后性功能的影响。方法 对我院2004年2月至2006年5月期间21例中低位直肠癌患者施行腹腔镜全直肠系膜切除保留盆腔自主神经手术，调查了解患者术后性功能情况。结果 21例患者性功能均存在,绝大多数(18例)患者勃起功能良好。结论 腹腔镜下全直肠系膜切除术保留盆腔自主神经是可行的，患者性功能恢复满意。
摘要:目的: 随机对照研究、评估生物反馈训练治疗慢性功能性便秘的疗效。 方法 : 60例慢性功能性便秘患者,随机分为治疗组30例和对照组30例。治疗组接受1个疗程(5周)生物反馈训练治疗(10次为一个疗程、一次30～45分钟、每周2次)。对照组患者接受聚乙二醇4000 10g BID 口服,疗程5周。治疗前后作便秘症状评分、结肠通过试验检测、直肠肛门压力检测。 结果 : 生物反馈训练和聚乙二醇4000均可使多数慢性功能性便秘患者的大便次数、大便性状及伴随症状恢复正常或缓解,总有效率分别为667%和80%(P ＞005)。生物反馈训练和聚乙二醇4000口服治疗后,结肠通过试验72小时标志物排出率分别为75%及73%,均较治疗前明显增加。生物反馈训练治疗后力排时肛门压明显下降。 结论 : 生物反馈训练对出口梗阻型、慢传输型便秘均有效,是一种有效的、新兴的治疗慢性功能性便秘的方法,可作为功能性便秘的一线治疗方法。Abstract: Objective: To assess the clinic effect of biofeedback therapy for functional constipation. Methods : Sixty cases of chronic functional constipation were randomly divided into treatment group (30 cases) and control group (30 cases). Cases in the treatment group were exposed to biofeedback for a fiveweeklong treatment course—individual treatment lasted for 3045 minutes and twice per week. Patients in the control group received PEG 4000 10g BID for five weeks. Data from constipation symptom score, colonic transit test, and anorectal manometry were done and compared before and after two kinds of treatments. Results : Biofeedback training and PEG 4000 could restore the stoolfrequency, stool characteristics and accompanying symptoms to normal or mitigation of the majority of patients with chronic functional constipation, with the total effective rates being 667% and 80% (P gt;005), respectively. After biofeedback training and PGE 4000 treatment, the discharge rate of 72hour markers of colonic transit test significantly increased to 75% and 73%, respectively. Additionally, anorectal pressure decreased dramatically after biofeedback training. Conclusion : Biofeedback training would play a positive role in outlet obstruction and slow transit constipation. Thus, it could be an effective firstline treatment of chronic functional constipation.
Objective To study the relationship between autonomic nerve preservation and sexual and urinary functions after total mesorectal excision in patients with cancer of the lower rectum, and to explore improved nursing methods for these patients. Methods Eligible patients with cancer of the lower rectum were non-randomly assigned to either a control group (n=278)or an autonomic nerve-preserving group （n=263）. The recovery time of micturition desire, catherization time, lower urinary tract infection rate, residual urine, severity of urinary disorders and sexual disorders were observed. Results The recovery time of micturition desire, catherization time, lower urinary tract infection rate, residual urine, severity of urinary disorders and sexual disorders were lower in the autonomic nerve-preserving group than in the control group. (Plt;0.05) . Conclusion Autonomic nerve preservation radical resection leads to better maintenance of urinary and sexual functions for patients with cancer of the lower rectum. Nursing should be focused on the prevention of urinary tract complications and the rehabilitation of sexual and urinary functions.
ObjectiveTo systematically evaluate the effects of weight-loss interventions on hormone levels and sexual function in patients with obesity. MethodsThis review was conducted in accordance with PRISMA guidelines. A systematic search of PubMed, EMBASE, and other databases was performed for studies published within the past decade that investigated the effects of bariatric surgery, glucagon-like peptide 1 (GLP-1)-based medications, and lifestyle interventions on sex hormones and sexual function. ResultsBariatric surgery (e.g., sleeve gastrectomy, gastric bypass) demonstrated the most pronounced improvements in hormonal balance and sexual function. In males, total testosterone levels doubled postoperatively, with marked increase in erectile function score. In females with polycystic ovary syndrome, androgen levels were reduced by 50%, with significant amelioration in the female sexual function index. GLP-1 receptor agonists (e.g., semaglutide, liraglutide) partially improved sperm quality and testosterone levels, but were also associated with a higher risk of erectile dysfunction (hazard ratio = 4.5). Lifestyle interventions (e.g., low-calorie diet, exercise) could increase sex hormone-binding globulin levels and improve sexual function score, although their efficacy remained inferior to that of surgery. ConclusionsWeight-loss interventions can alleviate hormonal imbalances and sexual dysfunction in obesity, with surgery demonstrating the most significant effects. Pharmacological and lifestyle interventions have shown variable efficacy. Future research should further investigate mechanisms underlying effects of different weight-loss modalities on sexual health.
Objective To systematically review the effect of bariatric surgery for male’s erectile function. Methods We electronically searched databases including PubMed, EMbase, The Cochrane Library (Issue 5, 2016), CNKI, VIP and WanFang Data from inception to May 30th 2016, to collect randomized controlled trials and before-after studies about bariatric surgery therapies for erectile function in obese male. Two reviewers independently screened literature, extracted data, and assessed the methodological quality of included studies. Then RevMan 5.3 software was used for meta-analysis. Results A total of 7 before-after studies involving 270 patients were included. The results of meta-analysis showed that: compared with before treatment, bariatric surgery could significantly improve 1-year erectile function score (MD=5.05, 95%CI 3.52 to 6.59, P < 0.000 01), 1-year sexual desire score (MD=0.99, 95%CI 0.47 to 1.51, P=0.000 2), 1-year contact satisfaction score (MD=2.70, 95%CI 0.21 to 5.19, P=0.004) and 1-year total satisfaction score (MD=1.68, 95%CI 0.27 to 3.09, P=0.002), but there was no significant difference in orgasm function score (MD= –0.21, 95%CI –0.74 to 0.33, P=0.45) between before and after treatment. Conclusion Bariatric surgery is effective in improving the erectile function, sexual desire and sexual satisfaction in morbidly obese male. Due to the limited quality and quantity of the included studies, the above conclusion needs to be verified by more large-scale high-quality studies.
ObjectiveTo systematically review the association between 5α-reductase inhibitors (5ARIs) and risk of sexual dysfunction in subjects with benign prostatic hyperplasia (BPH).MethodsPubMed, Web of Science, The Cochrane Library, EMbase, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect studies on the association between 5ARIs and risk of sexual dysfunction in subjects with BPH from inception to October 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed by using Stata 12.0 software.ResultsA total of 15 studies involving 17 774 subjects were included. The results of the meta-analysis showed that compared with the placebo group, 5ARIs could significantly increase risk of erectile dysfunction (RR=1.52, 95%CI 1.36 to 1.69, P<0.000 1), while decrease libido (RR=1.79, 95%CI 1.37 to 2.32, P<0.000 1) and ejaculation disorder (RR=2.97, 95%CI 1.82 to 4.83, P<0.000 1) in subjects with BPH. Subgroup analysis of the type of 5ARIs, intervention period, publication year and sample size showed that the 5ARIs had a higher risk of sexual dysfunction than the placebo group.ConclusionsCurrent evidence shows that 5ARIs can increase risk of erectile dysfunction, decrease libido and ejaculation disorder in subjects with BPH. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusions.