agxАндрология и генитальная хирургияAndrology and Genital Surgery2070-97812412-890210.17650/2070-9781-2017-18-4-12-18agx-255Research ArticleОБЗОРНАЯ СТАТЬЯREVIEWЭректильная функция после эндоскопических операций по удалению гиперплазии предстательной железыErectile function after endoscopic surgery for prostatic hyperplasia removalГлыбочкоП. В.GlybochkoP. V.

Россия, 119991 Москва, ул. Большая Пироговская, 2, стр. 1

2–1 Bolshaya Pirogovskaya St., Moscow 119991, Russia

АляевЮ. Г.AlyaevYu. G.

Россия, 119991 Москва, ул. Большая Пироговская, 2, стр. 1

2–1 Bolshaya Pirogovskaya St., Moscow 119991, Russia

РапопортЛ. М.RapoportL. M.

Россия, 119991 Москва, ул. Большая Пироговская, 2, стр. 1

2–1 Bolshaya Pirogovskaya St., Moscow 119991, Russia

ЕникеевД. В.EnikeevD. V.

Россия, 119991 Москва, ул. Большая Пироговская, 2, стр. 1

2–1 Bolshaya Pirogovskaya St., Moscow 119991, Russia

АхвледианиН. Д.AkhvledianiN. D.

Россия, 119991 Москва, ул. Большая Пироговская, 2, стр. 1

2–1 Bolshaya Pirogovskaya St., Moscow 119991, Russia

СпивакЛ. Г.SpivakL. G.

Россия, 119991 Москва, ул. Большая Пироговская, 2, стр. 1

2–1 Bolshaya Pirogovskaya St., Moscow 119991, Russia

ЧерновЯ. Н.ChernovYa. N.

Россия, 119991 Москва, ул. Большая Пироговская, 2, стр. 1

2–1 Bolshaya Pirogovskaya St., Moscow 119991, Russia

ЛаухтинаЕ. А.LaukhtinaE. A.

Россия, 119991 Москва, ул. Большая Пироговская, 2, стр. 1

2–1 Bolshaya Pirogovskaya St., Moscow 119991, Russia

ДымоваА. В.DymovaA. V.

Россия, 119991 Москва, ул. Большая Пироговская, 2, стр. 1

2–1 Bolshaya Pirogovskaya St., Moscow 119991, Russia

ТараткинМ. С.TaratkinM. S.

Россия, 119991 Москва, ул. Большая Пироговская, 2, стр. 1

2–1 Bolshaya Pirogovskaya St., Moscow 119991, Russia

marktaratkin@gmail.comНИИ уронефрологии и репродуктивного здоровья человека ФГАОУ ВО Первый Московский государственный медицинский университет им. И. М. Сеченова Минздрава РоссииРоссияResearch Institute of Uronephrology and Reproductive Health of the I. M. Sechenov First Moscow State Medical University, Ministry of Health of RussiaRussian Federation2017300120181841218Copyright © Глыбочко П.В., Аляев Ю.Г., Рапопорт Л.М., Еникеев Д.В., Ахвледиани Н.Д., Спивак Л.Г., Чернов Я.Н., Лаухтина Е.А., Дымова А.В., Тараткин М.С., 20182018Глыбочко П.В., Аляев Ю.Г., Рапопорт Л.М., Еникеев Д.В., Ахвледиани Н.Д., Спивак Л.Г., Чернов Я.Н., Лаухтина Е.А., Дымова А.В., Тараткин М.С.Glybochko P.V., Alyaev Y.G., Rapoport L.M., Enikeev D.V., Akhvlediani N.D., Spivak L.G., Chernov Y.N., Laukhtina E.A., Dymova A.V., Taratkin M.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://agx.elpub.ru/jour/article/view/255Введение

Введение. Доброкачественная гиперплазия предстательной железы (ДГПЖ) на сегодняшний день встречается у 50 % мужчин старше 50 лет и у 80 % – старше 80 лет.  Наиболее эффективный метод лечения ДГПЖ –хирургическое удаление аденомы предстательной железы (ПЖ). Он позволяет быстро снять инфравезикальную  обструкцию мочевых путей, но при этом повышается вероятность развития эректильной  дисфункции, одного из наиболее значимых возможных осложнений. В работе освещено  влияние на эректильную функцию (ЭФ) методов эндоскопического удаления ДГПЖ: моно- и  биполярной трансуретральной резекции (ТУР) ПЖ, гольмиевой (HoLEP) и тулиевой (ThuLEP)  лазерных энуклеаций, вапоризации ПЖ. Представлены эволюция современных лазерных технологий и изменение в связи с этим подхода к сохранению ЭФ при лечении аденомы ПЖ.

Цель настоящей работы – обсуждение возможных механизмов нарушения ЭФ после эндоскопических операций по удалению ДГПЖ, а также выяснение, какой из механизмов и  почему является наиболее вероятной причиной возникновения послеоперационной эректильной дисфункции.

Вывод

Вывод. По имеющимся данным такие методики, как биполярная ТУР ПЖ, HoLEP и ThuLEP, не оказывают на эрекцию существенного отрицательного влияния. Более того, в некоторых  случаях процесс ее восстановления занимает существенно меньше времени при  использовании ThuLEP, поэтому проведение последней следует рекомендовать пациентам,  заинтересованным в скором восстановлении ЭФ.

Introduction

Introduction. Currently, benign prostatic hyperplasia (BPH) is diagnosed in 50 % of men aged 50 and older and in 80 % of men aged 80 and older. The most effective treatment method is surgical  removal of prostate adenoma. It allows to quickly remove  infravesical urinary tract obstruction, but at the same time it  increases the risk of erectile dysfunction, one of the most important  possible complications. The rate of this complication was significantly decreased by implementation of modern laser technology in  urological practice.

The study considers the effect of different methods of endoscopic removal of BPH on erectile function (EF): mono- and bipolar transurethral resection (TUR) of the prostate, holmium (HoLEP) and  thulium (ThuLEP) laser enucleation, prostate vaporization. Evolution  of modern laser technologies and changes in approaches to  preservation of EF in treatment of prostate adenoma are presented. The study objective is to discuss possible mechanisms of  EF disorders after endoscopic surgeries for BPH removal, as well as  to identify which of the mechanisms is the most probable cause of postoperative erectile dysfunction.

Conclusion

Conclusion. According to the available data, such methods as bipolar TUR of the prostate, HoLEP, and ThuLEP do not negatively affect erection in any significant way. Moreover, in some cases its  recovery is significantly quicker after ThuLEP; therefore, the last  method is recommended for patients interested in quick EF recovery.

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The authors declare that there are no conflicts of interest present.