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北京大学学报（医学版） ›› 2026, Vol. 58 ›› Issue (4): 762-769. doi: 10.19723/j.issn.1671-167X.2026.04.012

• 论著 • 上一篇    下一篇

经尿道铥激光剜除术与电切术对前列腺增生术后患者性功能的影响：一项回顾性队列研究

陈凯月1,*, 于书慧1,*, 韩佳凝1, 刘梓薇1, 马佳卉2, 张凯1, 孟一森1,*(), 车新艳1,*()   

  1. 1. 北京大学第一医院泌尿外科，北京 100034
    2. 北京大学第一医院麻醉科，北京 100034
  • 收稿日期:2026-02-27 出版日期:2026-08-18 发布日期:2026-06-05
  • 通讯作者: 孟一森, 车新艳
  • 作者简介:

    *These authors contributed equally to this work

  • 基金资助:
    研究型病房卓越临床研究计划(BRWEP2024W054070103); 中华人民共和国工业和信息化部与国家卫生健康委员会掺铥光纤激光治疗机推广应用项目(2024TGYY33); 中央高水平医院临床科研业务费(北京大学第一医院科研种子基金项目)(2024SF80); 中央高水平医院临床科研业务费(北京大学第一医院科研种子基金项目)(2025SF083)

Impact of thulium laser enucleation of the prostate versus transurethral resection of the prostate on sexual function in patients with benign prostatic hyperplasia: A retrospective cohort study

Kaiyue CHEN1, Shuhui YU1, Jianing HAN1, Ziwei LIU1, Jiahui MA2, Kai ZHANG1, Yisen MENG1,*(), Xinyan CHE1,*()   

  1. 1. Department of Urology, Peking University First Hospital, Beijing 100034, China
    2. Department of Anesthesiology, Peking University First Hospital, Beijing 100034, China
  • Received:2026-02-27 Online:2026-08-18 Published:2026-06-05
  • Contact: Yisen MENG, Xinyan CHE
  • Supported by:
    Clinical Research Program for Researching Hospital Wards(BRWEP2024W054070103); Ministry of Industry and Information Technology of the People' s Republic of China (MIIT) and National Health Commission of the People' s Republic of China (NHC) under the Thulium Fiber Laser Equipment Promotion and Application Project(2024TGYY33); National High Level Hospital Clinical Research Funding (Scientific Research Seed Fund of Peking University First Hospital)(2024SF80); National High Level Hospital Clinical Research Funding (Scientific Research Seed Fund of Peking University First Hospital)(2025SF083)

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摘要：

目的: 比较经尿道铥激光前列腺剜除术(thulium laser enucleation of the prostate，ThuLEP)与前列腺电切术(transurethral resection of the prostate，TURP)治疗良性前列腺增生(benign prostatic hyperplasia，BPH)对性功能的影响。方法: 采用回顾性队列方法，便利选取2022年1月至2023年12月在北京大学第一医院泌尿外科接受ThuLEP和TURP手术治疗的患者临床资料，采用倾向性评分法匹配两组术前基线数据。记录匹配后两组围手术期的手术时间、术中出血量、血红蛋白下降值、切除前列腺腺体重量、膀胱冲洗时间、留置导尿管时间及住院时间等指标，收集两组术前、术后1个月及12个月的相关指标。比较两组性功能指标和排尿改善指标，包括国际勃起功能指数-5(international index of erectile function，IIEF-5)评分、逆行射精发生率，以及国际前列腺症状评分(international prostate symptom score，IPSS)、生活质量评分(quality of life，QOL)。结果: 本研究倾向性匹配后共纳入ThuLEP组与TURP组各98例患者，术前两组患者在年龄、前列腺体积、IIEF-5评分、逆行射精发生率、IPSS、QOL等方面差异均无统计学意义(P＞0.05)，表明两组间具有可比性。在勃起功能方面，ThuLEP组和TURP组患者术后1个月、术后12个月的IIEF-5评分分布与术前相比，差异均无统计学意义(P＞0.05);术后1个月时ThuLEP组与TURP组的IIEF-5评分分布差异无统计学意义(P＞0.05), 但术后12个月时ThuLEP组重度勃起功能障碍发生率显著低于TURP组(Z=8.522，P=0.036)。在射精功能方面，ThuLEP组和TURP组在术后1个月和12个月时的逆行射精发生率与术前相比，差异均有统计学意义(P＜0.05)，且随着术后时间延长，两组逆行射精发生率均逐渐升高；术后1个月和12个月时，逆行射精发生率在ThuLEP组和TURP组间差异均无统计学意义(9.2% vs. 14.3%，Z=1.231，P=0.267；19.4% vs. 25.5%，Z=1.055，P=0.304)。两组手术时间、术中出血量、血红蛋白下降值、切除前列腺腺体重量比较，差异均无统计学意义(P＞0.05)；与TURP组相比，ThuLEP组住院时间更短(4 d vs. 5 d，P＜0.001)、留置导尿管时间更短(3.67 d vs. 4.26 d，P=0.012)，但膀胱冲洗时间更长(19.00 h vs. 16.68 h，P=0.001)。术后1个月及12个月的IPSS、QOL在两组间差异均无统计学意义(P＞0.05)，但均较术前有显著改善。结论: ThuLEP和TURP均能改善患者的下尿路症状和排尿情况，ThuLEP在保护勃起功能、促进术后恢复方面更具潜在优势。

关键词: 前列腺增生, 经尿道前列腺切除术, 激光疗法, 铥激光, 性功能障碍，生理性

Abstract:

Objective: To compare the effects of thulium laser enucleation of the prostate (ThuLEP) and monopolar transurethral resection of the prostate (TURP) on sexual function in patients with benign prostatic hyperplasia (BPH). Methods: A retrospective cohort study was conducted involving patients who underwent ThuLEP or TURP at the Department of Urology, Peking University First Hospital, between January 2022 and December 2023. Participants were recruited via convenience sampling. Propensity score matching (PSM) was subsequently employed to balance preoperative baseline characteristics between the two cohorts.Following propensity score matching, we conducted a comparative analysis of sexual function and voiding improvement metrics between the two cohorts. Sexual function was assessed using the international index of erectile function-5 (IIEF-5) scores and the incidence of retrograde ejaculation. Voiding outcomes were evaluated based on the international prostate symptom score (IPSS), qua-lity of life (QOL) scores. Results: Following propensity score matching, the study included 98 patients in both the ThuLEP and the TURP groups. Preoperative comparisons between the two groups regarding age, prostate volume, IIEF-5 scores, incidence of retrograde ejaculation, IPSS, and QOL showed no statistically significant differences (P>0.05), indicating comparability between the groups. Regarding erectile function, postoperative IIEF-5 scores at 1 month and 12 months in both the ThuLEP and TURP groups did not differ significantly from preoperative scores (P>0.05). At 1 month postoperatively, there was no significant difference in IIEF-5 scores between the ThuLEP and TURP groups (P>0.05). At the 12-month postoperative follow-up, the incidence of severe erectile dysfunction was significantly lower in the ThuLEP group compared with the TURP group (Z=8.522, P=0.036). Regarding ejaculatory function, the incidence of retrograde ejaculation at 1 month and 12 months postoperatively in both the ThuLEP and TURP groups differed significantly from preoperative rates (P < 0.05). Moreover, the incidence of retrograde ejaculation increased with time after surgery. At 1 month postoperatively, 9.2% of the ThuLEP group and 14.3% of the TURP group experienced retrograde ejaculation, which was not statistically different (Z=1.231, P=0.267). At 12 months postoperatively, the incidence of retrograde ejaculation in the ThuLEP and TURP groups was 19.4% and 25.5%, respectively, also showing no significant difference (Z=1.055, P=0.304). In terms of surgical parameters, comparisons of operative time, intraoperative blood loss, decrease in hemoglobin levels, and weight of resected prostate tissue between the ThuLEP and TURP groups revealed no significant differences (P>0.05). However, compared with the TURP group, the ThuLEP group had a shorter hospital stay (4 d vs. 5 d, P < 0.001) and shorter duration of indwelling urinary catheterization (3.67 d vs. 4.26 d, P=0.012), although bladder irrigation time was longer (19.00 h vs. 16.68 h, P=0.001). At 1 month and 12 months postoperatively, there were no significant differences between the two groups in IPSS, QOL metrics (P>0.05); how- ever, all these parameters showed significant improvement compared with preoperative values. Conclusion: While both ThuLEP and TURP effectively alleviate lower urinary tract symptoms and improve voiding parameters, ThuLEP offers distinct advantages in safeguarding erectile potency and facilitating accelerated postoperative recovery.

Key words: Prostatic hyperplasia, Transurethral resection of prostate, Laser therapy, Thulium laser, Sexual dysfunction, physiological

中图分类号: 

  • R697.32

表1

ThuLEP组和TURP组患者的基线资料"

Items TURP (n=98) ThuLEP (n=98) Statistical value P value
Age/years, $\bar x \pm s$ 68.04±6.98 68.62±7.07 -0.580 0.563
Prostate size/mL, $\bar x \pm s$ 98.85±42.38 96.16±46.12 0.426 0.671
Qmax/(mL/s), $\bar x \pm s$ 8.21±3.43 7.97±3.74 0.474 0.636
PVR/mL, M (P25, P75) 74.53 (19.00, 88.10) 74.53 (25.50, 74.53) -0.111 0.911
PSA/(μg/L), M (P25, P75) 4.01 (2.13, 7.82) 4.37 (2.24, 7.82) -0.325 0.745
IPSS, $\bar x \pm s$ 25.51±8.62 27.02±8.49 -1.236 0.218
QOL, $\bar x \pm s$ 4.95±1.09 5.16±1.01 -1.428 0.155
IIEF-5, n(%) 2.057 0.561
  No ED 5 (5.1) 2 (2.0)
  Mild and moderate ED 37 (37.8) 39 (39.8)
  Severe ED 11 (11.2) 15 (15.3)
  Asexual activity 45 (45.9) 42 (42.9)
RE, n(%) 3.047 0.081
  Yes 3 (3.1) 0 (0)
  No 95 (96.9) 98 (100.0)

表2

ThuLEP组和TURP组患者围手术期指标"

Items TURP (n=98) ThuLEP (n=98) Statistical value P value
Operative time/min, $\bar x \pm s$ 60.33±28.91 64.53±29.91 -1.036 0.320
Resected prostate weight/g, $\bar x \pm s$ 50.35±25.34 47.71±22.50 0.770 0.442
Intraoperative blood loss/mL, M (P25, P75) 0.0 (5.0, 22.5) 0.0 (5.0, 50.0) -0.584 0.559
Hemoglobin decrease/(g/L)，$\bar x \pm s$ 16.75±11.86 15.44±9.83 0.842 0.401
Hospital stay/d, M (P25, P75) 5 (5, 5) 4 (4, 5) -4.789 ＜0.001
Cathererization time/d, $\bar x \pm s$ 4.26±1.71 3.67±1.50 2.531 0.012
Bladder irrigation time/h, $\bar x \pm s$ 16.68±3.81 19.00±5.89 -3.268 0.001

表3

ThuLEP组和TURP组患者术后1个月和12个月的随访资料"

Items 1-month postoperative follow-up
TURP (n=98) ThuLEP (n=98) Statistical value P value
IPSS, $\bar x \pm s$ 4.99±4.08 4.80±4.33 0.323 0.747
QOL, M (P25, P75) 5.00 (4.00, 6.00) 6.00 (4.00, 6.00) -1.343 0.179
IIEF-5, n(%) 5.024 0.170
  No ED 7 (7.1) 8 (8.2)
  Mild and moderate ED 22 (22.4) 15 (15.3)
  Severe ED 16 (16.3) 28 (28.6)
  Asexual activity 53 (54.1) 47 (48.0)
RE, n(%) 1.231 0.267
  Yes 14 (14.3) 9 (9.2)
  No 84 (85.7) 89 (90.8)
Items 12-month postoperative follow-up
TURP (n=98) ThuLEP (n=98) Statistical value P value
IPSS, $\bar x \pm s$ 3.95±3.95 3.64±3.70 0.560 0.576
QOL, M (P25, P75) 1.00 (0.00, 1.37) 1.00 (0.00, 2.00) -0.489 0.625
IIEF-5, n(%) 8.522 0.036
  No ED 8 (8.2) 12 (12.2)
  Mild and moderate ED 29 (29.6) 30 (30.6)
  Severe ED 16 (16.3) 4 (4.1)
  Asexual activity 45 (45.9) 52 (53.1)
RE, n(%) 1.055 0.304
  Yes 25 (25.5) 19 (19.4)
  No 73 (74.5) 79 (80.6)

表4

ThuLEP组不同时间点IIEF-5评分和RE率的配对比较"

Items Baseline 1 month after surgery 12 months after surgery Baseline vs. 1 month after surgery Baseline vs. 12 months after surgery 1 month after surgery vs. 12 months after surgery
Z P Z P Z P
IIEF-5，n(%) -1.875 0.061 -0.074 0.941 -1.686 0.092
  No ED 2 (2.0) 8 (8.2) 12 (12.2)
  Mild and moderate ED 39 (39.8) 15 (15.3) 30 (30.6)
  Severe ED 15 (15.3) 28 (28.6) 4 (4.1)
  Asexual activity 42 (42.9) 47 (48.0) 52 (53.1)
RE, n(%) -3.000 0.003 -4.359 ＜0.001 -2.132 0.033
  Yes 0 (0) 9 (9.2) 19 (19.4)
  No 98 (100) 89 (90.8) 79 (80.6)

表5

TURP组不同时间点IIEF-5评分和RE率的配对比较"

Items Baseline 1 month after surgery 12 months after surgery Baseline vs. 1 month after surgery Baseline vs. 12 months after surgery 1 month after surgery vs. 12 months after surgery
Z P Z P Z P
IIEF-5, n(%) -1.630 0.103 -0.261 0.794 -1.217 0.224
  No ED 5 (5.1) 7 (7.1) 8 (8.2)
  Mild and moderate ED 37 (37.8) 22 (22.4) 29 (29.6)
  Severe ED 11 (11.2) 16 (16.3) 16 (16.3)
  Asexual activity 45 (45.9) 53 (54.1) 45 (45.9)
RE, n(%) -2.840 0.005 -4.491 ＜0.001 -2.200 0.028
  Yes 3 (3.1) 14 (14.3) 25 (25.5)
  No 95 (96.9) 84 (85.7) 73 (74.5)
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ISSN 1671-167X
CN 11-4691/R
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