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目的探讨膀胱全切术后男性患者勃起功能障碍及西地那非治疗效果。方法回顾性分析1997年6月～2005年2月53例膀胱全切患者临床资料。年龄35～62岁,平均51岁。32例行原位回肠膀胱术,21例行Bricker回肠膀胱术。保留血管神经束者28例,未保留血管神经束者25例。采用勃起功能国际问卷-5(IIEF-5)评估术前、术后及西地那非治疗前后勃起功能状况。结果随访16～47月,53例膀胱全切患者ED发生率为73.6%,其IIEF-5评分由术前(21.6±3.8)下降至(4.3±5.1)(P<0.05)。保留血管神经束膀胱全切ED发生率为57%,而未保留血管神经束者ED发生率为92%。39例ED患者中,13例应用西地那非治疗,其中9例保留血管神经束者治疗前后IIEF-5评分分别为(5.3±1.2)和(20.6±2.3)(P<0.05);而未保留血管神经束者治疗前后IIEF-5评分分别为(2.0±1.4)和(2.6±1.7)(P>0.05)。结论勃起功能障碍是膀胱全切术后常见并发症。保留血管神经束可保留部分患者的勃起功能,同时也是应用西地那非治疗成功的关键。
Objective To investigate the erectile dysfunction in male patients after mastectomy and the effect of sildenafil treatment. Methods The clinical data of 53 patients with complete bladder resection from June 1997 to February 2005 were retrospectively analyzed. Age 35 to 62 years, mean 51 years. 32 cases of ileal bladder surgery, 21 cases of Bricker ileum bladder surgery. Twenty-eight patients retained vascular bundle and 25 patients did not retain vascular bundle. The erectile function questionnaire-5 (IIEF-5) was used to evaluate the erectile function before and after treatment with sildenafil. Results The follow-up of 16 to 47 months, the 53 cases of complete resection of the bladder in patients with ED incidence was 73.6%, the IIEF-5 score from preoperative (21.6 ± 3.8) decreased to (4.3 ± 5.1) (P <0.05). The rate of total ED with preserving vascular bundle was 57%, while the ED without preserving vascular bundle was 92%. Among the 39 patients with ED, 13 were treated with sildenafil, and 9 of the 9 patients with preserved vascular bundle had (5.3 ± 1.2) and (20.6 ± 2.3) before and after treatment, respectively (P <0.05) The IIEF-5 scores before and after preserving vascular bundle were (2.0 ± 1.4) and (2.6 ± 1.7), respectively (P> 0.05). Conclusion Erectile dysfunction is a common complication after total cystectomy. Retaining the vascular bundle can preserve the erectile function of some patients and is also the key to successful sildenafil use.