小儿泌尿外科常用手术对生殖健康和性健康的长期影响。

IF 2.6 4区 医学 Q2 UROLOGY & NEPHROLOGY
Therapeutic Advances in Urology Pub Date : 2024-05-09 eCollection Date: 2024-01-01 DOI:10.1177/17562872241249083
Alexandra Geada, Dhaval Jivanji, Daniel M Tennenbaum, Armin Ghomeshi, Raghuram Reddy, Michael Sencaj, Jamie Thomas, Daniel E Nassau, Ranjith Ramasamy
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引用次数: 0

摘要

简介性功能障碍在育龄男性中非常普遍。目前已制定了临床实践指南,以帮助医疗工作者识别和教育因某些先天性和后天性泌尿生殖系统疾病而增加不育和性功能障碍风险的患者。作者试图回顾用常用外科手术治疗常见儿童泌尿系统疾病对生殖健康和性健康的影响:为了确保纳入有影响力和备受推崇的研究,我们优先引用了与我们各自的综述主题相关的最常被引用的文章。我们的纳入标准考虑了样本量大、方法设计严谨的研究。我们对多个主题进行了综述,包括阴茎硬结症、尿道下裂、后尿道瓣膜、精索静脉曲张、睾丸下降不全和睾丸扭转:结果:对于阴茎硬结症,可采用手术切除或体外移植的方法。勃起功能在术后保持不变,而阴茎长度在修复后可能会缩短,使用真皮移植可避免这种情况。尿道下裂修复取决于严重程度和尿道板的可用性。接受尿道下裂修补术的患者报告阴茎长度减少,但性生活满意度、性欲和精液质量与对照组相当。后尿道瓣膜通常采用瓣膜消融术进行治疗。虽然尚未发现瓣膜消融术和膀胱颈切开术会影响射精功能,但与肾功能障碍和膀胱功能障碍相关的高度并发肾功能障碍可能会影响精液参数和勃起功能。关于精索静脉曲张,早期治疗与更好的长期生育结果相关,如果出现明显的睾丸萎缩,建议进行手术干预。研究发现,尽早通过睾丸环切术修复未降睾丸可提高生育率并降低恶性肿瘤发生率。对睾丸扭转进行单侧睾丸切除术而无法挽救的结果表明,精液参数会下降,但生育率不受影响:结论:不育症和性功能障碍是多变量实体,病因既有先天性的,也有后天性的。同时,许多常见的小儿泌尿外科手术都是为了纠正可能导致成年后生殖功能障碍的解剖病理。本综述强调了诊断和管理小儿泌尿科疾病的必要性,因为这些疾病可能会影响术后的长期性功能。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Long-term impact of commonly performed operations in pediatric urology on reproductive and sexual health.

Introduction: Sexual dysfunction is highly prevalent among men of reproductive age. Clinical practice guidelines have been established to assist providers in identification and education of patients who are at increased risk for infertility and sexual dysfunction with certain congenital and acquired urogenital disorders. The authors sought to review the reproductive and sexual health implications of treating common childhood urological conditions with commonly performed surgical procedures.

Methods: To ensure the inclusion of influential and highly regarded research, we prioritized citations from the most-frequently cited articles on our respective review topics. Our inclusion criteria considered studies with substantial sample sizes and rigorously designed methodologies. Several topics were reviewed, including penile chordee, hypospadias, posterior urethral valves, varicoceles, undescended testicles, and testicular torsion.

Results: For chordee, surgical plication or corporal grafting may be employed. Erectile function remains unaltered post-surgery, while penile length may decrease after repair, which may be avoided using dermal grafts. Hypospadias repair hinges on severity and availability of the urethral plate. Those who underwent hypospadias repair report decreased penile length, but sexual satisfaction, libido, and semen quality are comparable to controls. Posterior urethral valves are usually treated with valve ablation. While valve ablation and bladder neck incision have not been found to affect ejaculatory function, high degree of concurrent renal dysfunction related to nephrogenic and bladder dysfunction may impact semen parameters and erectile function. Regarding varicocele, earlier management has been associated with better long-term fertility outcomes, and surgical intervention is advisable if there is observable testicular atrophy. Earlier repair of undescended testicle with orchiopexy has been found to improve fertility rates as well as decrease malignancy rates. Unilateral orchiectomy for testicular torsion without the ability for salvage has been shown to have decreased semen parameters but unaffected fertility rates.

Conclusion: Infertility and sexual dysfunction are multivariable entities, with etiologies both congenital and acquired. At the same time, many common pediatric urology surgeries are performed to correct anatomic pathology that may lead to reproductive dysfunction in adulthood. This review highlights the need for diagnosis and management of pediatric urologic conditions as these conditions may impact long-term sexual function post-operatively.

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来源期刊
CiteScore
3.70
自引率
0.00%
发文量
39
审稿时长
10 weeks
期刊介绍: Therapeutic Advances in Urology delivers the highest quality peer-reviewed articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of urology. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in urology, providing a forum in print and online for publishing the highest quality articles in this area. The editors welcome articles of current interest across all areas of urology, including treatment of urological disorders, with a focus on emerging pharmacological therapies.
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