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

doi:10.19723/j.issn.1671-167X.2026.04.012

Abstract

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

CLC Number:

R697.32

Kaiyue CHEN, Shuhui YU, Jianing HAN, Ziwei LIU, Jiahui MA, Kai ZHANG, Yisen MENG, Xinyan CHE. 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[J].Journal of Peking University (Health Sciences), 2026, 58(4): 762-769.

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References 25

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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)

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

Items	1-month postoperative follow-up
Items	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
Items	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)

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
Items	Baseline	1 month after surgery	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)

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
Items	Baseline	1 month after surgery	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)

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

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