背景: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射精。未能以粒状方式评估功能失调的射精和相关的打扰可能会低估该人群中射精功能障碍的患病率和重要性。
目的:本范围审查提供了对现有工具评估射精功能和相关麻烦的批判性评估,强调充分了解历史的重要性,术前咨询,以及治疗前后应使用的补充问题。
方法:使用1946年至2022年6月的相关关键词进行了文献综述。合格标准包括BPH手术后出现射精功能障碍的男性。测量结果包括评估与射精功能相关的患者烦恼,男性性健康问卷(MSHQ)的术前和术后评分。和丹麦前列腺症状性功能域(DAN-PSSsex)。
结果:这项研究的结果仅包括10名患者,因为治疗后射精功能障碍而烦恼。在43/49研究中,术前和术后MSHQ被用作诊断工具,一项研究记录了“保留顺行射精”,其中一人使用了DAN-PSSsex。MSHQ的Q1-4用于33/43研究,3/43使用Q1、3、5-7,1/43仅使用Q4,1/43使用Q1-3+Q6和Q7,5/43使用整个MSHQ。没有研究使用射精后尿液分析来诊断逆行射精。只有四项研究明确记录了打扰,发现25-35%的患者在BPH手术后的性活动中被“缺乏射精”或“其他射精困难”困扰。
结论:目前没有研究根据射精的各种成分对患者进行分层(力,volume,一致性,精液驱逐的感觉,痛苦的射精,等。)BPH手术后。报告与BPH治疗相关的射精功能障碍存在改善的机会。需要全面的性健康史。需要进一步研究BPH手术治疗对患者射精经历的具体特征的影响。
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.