The results of the postoperative examination
In this study, 122 patients (95.3%) underwent transurethral resection of the prostate using the standard technique of performance on Barnes & Nesbit. In 6 cases (4.7%) held elektrovaporizatsiya prostate.
Only 2 patients (1.6%) during transurethral resection of a perforated surgical capsule of the prostate on a background of spontaneous reduction in its electrical stimulation in the process of implementation. In this regard, we believe that the final stage resection of the prostate should be carried out using standard electrodes and only the use of conventional modes of power (150-200 W).
In 18.75% of the cases made contact tsistolitotripsiya, 32 patients performed two-way vasoresection.
Surgical operations have the ability to inhibit the function of the endocrine glands, the degree of inhibition is directly proportional to traumatic running interference. When comparing the testosterone levels of blood plasma in patients after transurethral resection and electrovaporization in the immediate postoperative period revealed a significant decline in its first day with a tendency to reverse the growth of the first week. At the same time in patients undergoing elektrovaporizatsiyu, decrease in the concentration of this hormone is much more pronounced. This may indicate that at elektrovaporizatsii degree of traumatic physical impact on the prostate gland and surrounding tissue more. Based on these data we can conclude the high sensitivity of testicular tissue whose function is inhibited in response to injury prostate surgery for BPH.
After three months of monitoring results of the questionnaire (international index of erectile function scale quantification of the male copulative function) showed a slight decrease in the average maximum score, which indicates that on average, a rapid intervention is not a serious depotentsiruyuschego impact. However revealed declines in overall satisfaction with sexual intercourse, the state of the copulative function as a whole, as well as individual components of the copulative cycle: libido, erectile function, particularly ejaculatory component as a result of the postoperative symptoms of retrograde ejaculation. The greatest severity of copulative disorders observed in patients with weak sexual constitution, complications arise in the course of surgery, a significant hormonal imbalance, and severe concomitant diseases.
Data Analysis Hospital Anxiety and Depression Scale (GSHTD) revealed a decrease in the manifestations of anxiety-depressive syndrome at 3 months after surgery. Explanation of this fact, in our opinion, is a marked improvement in the quality of self-urination, especially for men socially active age. Thus, the very holding of surgery significantly reduces the severity of anxiety and depressive symptoms for most patients.
In 86% of patients surgery did not degrade the quality of erectile function, but for 29.7% of patients required an additional correction of erectile disorder whose symptoms were identified brand name levitra prior to surgery. In the presence of dominant complaints of dysuria, painful compelling urgency, intermittent difficulty urinating appointment a-adrenergic blockers leads to an improvement in erectile function in this background, 40% of patients. In patients with severe climacteric syndrome in combination with gipotestosteronemiey and / or hyperestrogenemia use of hormone replacement therapy with androgens is effective in 50% of cases. For people who have major complaints were the manifestation of anxiety-depressive syndrome, treatment of modern homeopathic anxiolytics had a positive effect in 60% of patients. Patients with manifestations of erectile dysfunction which could be explained by increased levels of prolactin plasma without significant changes in blood supply to the penis, dopamine agonist therapy (bromocriptine) is effective in about 75% of cases.
Of the total group of examined patients, 14% noted worsening of erectile function after endoscopic intervention. Attention is drawn to the fact that all these patients prior to surgery were identified certain symptoms of erectile dysfunction, although they lived sex life. Average prescription manifestations of benign prostatic giperaplazii - 4,9 years. Of all the patients in this group 66.7% were unmarried. Overweight as a risk factor for erectile dysfunction, was detected in 55.6% of cases. In all 18 patients had intercurrent illness, due to which 72.2% received concomitant therapy.
Complaints of patients were typical for erectile dysfunction, the most important of which were difficult to achieve a full erection (83.3%) episodes of detumescence without ejaculation (88,9%). In 77,8% of cases in the postoperative period revealed retrograde ejaculation, in 22,2% - partly antegrade with a decrease of sperm released. With 50% of patients attributed the deterioration of erectile function has arisen precisely with impaired ejaculation, confident retrograde ejaculation that imposes a substantial negative impact on the quality of erections. Giposteziya glans penis during intercourse was noted in 61.6% of cases that may be indirect evidence of a partial deinnervatsii body. Patients after bilateral vasoresection (33,3%) at the peak of sexual arousal marked soreness and discomfort in the groin, perineum and scrotum. Although according to world literature there is no direct relationship between vasoresection and deteriorating quality of erection, however, according to our observations in these patients the appearance of the above claims may negatively affect the quality of sexual intercourse.