Imibiko yokuhlola, izifundo kanye nolwazi lodokotela abane-PeniMaster PRO
I-PeniMaster PRO yokwelashwa kwangemva kokuhlinzwa komdlavuza wendlala yesinye Isifundo somtholampilo 2015/2016
- Umdlavuza wendlala yesinye: isimila esandile emadodeni aneminyaka ephakathi.
- Inani lezifo lenyuke ngamaphesenti angaphezu kuka-120 phakathi neminyaka eyi-10.
- Ukususwa kwe-prostate (prostatectomy) kuyindlela esunguliwe futhi enweba impilo yomdlavuza wendlala yesinye.
- Imiphumela emibi evamile nebalulekile:
- I-Libido (isifiso socansi) kanye nekhono lokuba ne-erection kuyahlupheka lapho i-prostate ikhishwa.
- Ubude bepipi buyancipha (ipipi liyafinyela).
- ukuphazamiseka kwe-ejaculation.
- Inhloso yocwaningo: Ukuphenywa kwamathuba okuthuthukisa izinga lempilo ngemva kwe-prostatectomy.
- Izihloko zocwaningo lomtholampilo: Amadoda angama-60 phakathi kweminyaka engama-60-69, ngemuva kokususwa kwe-prostate okuhlobene nomdlavuza.
- Ucwaningo lomtholampilo ngokuya ngamazinga omtholampilo wokuziphatha okuhle emhlabeni jikelele.
- Ukungasebenzi kahle kwe-Erectile kumdlavuza wendlala yesinye kwahlolwa njengengxenye yocwaningo.
- Kwakukhona amaqembu amathathu okuqhathanisa amadoda angama-20 lilinye:
- Iqembu 1: alitholanga i-prophylaxis yokugcina ubude be-penile kanye nomsebenzi we-erectile.
- Iqembu 2: Ithole ama-PDE-5 inhibitors izinyanga ezintathu ngemva kokuhlinzwa
- Iqembu lesi-3: Iphinde yasebenzisa i-peniMaster PRO okungenani amahora amathathu ngosuku.
Amathuba okwelashwa okuhlangene ukuze kugcinwe ukusebenza kocansi ezigulini eziye zathola i-radical postatectomy yomdlavuza wendawo we-prostate
Umdlavuza wendlala yesinye (i-PCa) ungesinye sezimila eziyingozi ezivame kakhulu emadodeni aneminyaka ephakathi kanye nasebekhulile futhi sikleliswe endaweni yesine esakhiweni sokugula kwezifo ze-oncological eRussia [1]. Eminyakeni eyishumi edlule, imvamisa yezifo ze-PCa iye yanda ngamaphesenti angaphezu kwe-120.5 [2].
Kuyaziwa ukuthi indlela yokwelapha ebaluleke kakhulu nesabalele yomdlavuza wendlala yesinye ukuhlinzwa. Ukwelashwa ngokuhlinzwa kuqinisekisa izinga lokusinda eliqondene nomdlavuza uma kuqhathaniswa namaqhinga okulinda nokubona [3].
Ngokwezincomo zomtholampilo ze-European Society of Urologists, i-radical prostatectomy (RRP) iyinqubo evamile yokwelashwa komdlavuza wendlala yesinye lapho isikhathi sokuphila esilindelwe isiguli siyiminyaka eyishumi nangaphezulu [4,5].
Umbuzo wokwandisa isikhathi sokuphila kweziguli eziye zahlushwa i-RRP uhlobene ngokuqondile nombuzo wokwandisa izinga lokuphila. I-RRP itholakale ihlotshaniswa nenani lokukhubazeka elikhawulela kakhulu izinga lokuphila, okuhlanganisa ukuncipha kwe-libido, ukungasebenzi kahle kwe-erectile, ukuncipha kobude be-penile, ukugoba kwe-penile, nokuphazamiseka kokuphuma kwe-ejaculation [6,7].
Ukubuyiselwa komsebenzi wezocansi ngemuva kokuthi i-RRP ifundwe isikhathi eside, kepha naphezu kwemiphumela yocwaningo eshicilelwe, akukho mbono ongavumelananga ngesimo sokusebenza kwe-erectile ngemuva kwe-RRP phakathi kwababhali baseRussia nabangaphandle [8,9,10,11, 12, 13]. Ithonya elikhulu lokungasebenzi kahle kwe-erectile kukhwalithi yokuphila lihambisana nesidingo kanye nesihloko sophenyo olwengeziwe esimweni sokusebenza kwe-erectile ezigulini eziye zahlupheka nge-RRP [14,15,16,17].
INHLOSO YOCWANINGO: Ukuhlola ukuthi kungenzeka yini ukwelashwa okuhlangene komsebenzi wocansi ezigulini eziye zathola i-prostatectomy enkulu yomdlavuza wendlala yesinye njengesici sokuthuthukisa izinga lempilo.
Isibhedlela Sedolobha No. 3 (Podgorbunsky Clinic, State Household Health Institution) e-Kemerovo1, Burnazâna Centre (Federal State Household Institution, Hematological Research Center, Federal Medical Center for Biophysics) ye-Federal Medicine and Biology Agency of Russia eMoscow2
Kyzlasov Pavel PhD Inhloko yomnyango urology
I-Federal Medical Biological Agency Burnasyan Federal Medical Biophysical Center
www.fmbcfmba.ru
Pomeshkin Evgeny PhD Inhloko yomnyango urology, Chief Urologist Kemerovo
MA Podgorbunsky City Hospital Municipal
www.gkb3.ru
IZIMPAHLA NEZINDLELA:
Ucwaningo lwamanje luhlanganisa amadoda angama-60 aneminyaka yobudala engama-64.6±4.7 anomdlavuza wendawo we-prostate oqinisekisiwe athole ukwelashwa ngaphansi kwemibandela yoMnyango We-Urology weSikhungo saseBurnazâna (Federal State Household Institution, Hematology Research Center, Federal Medical Center for Biophysics) kusukela ku-Federal Agency for Medicine and Biology yaseRussia eMoscow.
Zonke izivivinyo zesiguli zihambisana nezindinganiso zokuziphatha zeKomidi le-Bioethical, elathuthukiswa ngokuphathelene neSimemezelo sase-Helsinki se-World Medical Association "Izimiso Zokuziphatha Zocwaningo Lwezokwelapha Olubandakanya Abantu".
Abesilisa abaneminyaka engaphansi kwengama-70 kuphela ababengenayo i-somatic pathologies enzima, isifo sikashukela futhi ababenesithakazelo ekulondolozeni umsebenzi wocansi ngesikhathi sokuhlinzwa afakiwe ocwaningweni.
Kuzo zonke iziguli, inkomba yamazwe ngamazwe yomsebenzi we-erectile ngokusho kwemibuzo ye-IEF-5 kanye nekhwalithi yokuphila ngokusho kwemibuzo ye-QoL (Ikhwalithi yokuphila) yahlolwa phakathi nocwaningo. Ukwengeza, ubude be-penis (L) nokuqina kokuqina ngokwesilinganiso sokuqina kwe-erection (EHS) ye-penis (Tab. 1) kulinganiswa izikhathi ezintathu kuzo zonke iziguli, okwenza inani elilinganiselwe.
Ithebula 1 I-Penile Erection Erection Scale (EHS).
| Iziqu | |||
| 1 | 2 | 3 | 4 |
| Umthondo ukhulisiwe kodwa awuqini ngokwanele | Umthondo uqinile, kodwa awuqinile ngokwanele ukuthi ungangena | Ipipi liqine ngokwanele ukuthi lingangena, kodwa aliqinile ngokuphelele | Umthondo uqinile futhi uqinile |
Izilinganiso zokulawula zenziwa ngaphambi kokungenelela kokuhlinzwa kanye nezinsuku ezingu-7, 30 nezingu-90 ngemva kokungenelela kokuhlinzwa.
Ekuqaleni, iziguli ezibhalise ocwaningweni zonke zazingenawo umehluko omkhulu emlandweni womtholampilo kanye nezikolo zokusebenza. Ngokuhambisana nomklamo wocwaningo, iziguli zahlelwa ngamaqembu amathathu zisebenzisa itafula elingahleliwe. Iziguli zeqembu lokuqala (iqembu lokulawula, n = 20) azitholanga i-prophylaxis ethile yokugcina ubude be-penile kanye nomsebenzi we-erectile. Iziguli eziseqenjini lesibili (n=20) zathatha i-PDE-5 inhibitors ngomthamo we-5 mg nsuku zonke izinyanga ezintathu ngemuva kokuhlinzwa. Iziguli eziseqenjini lesithathu (n=20) zihlanganise ama-PDE-5 inhibitors ngethamo elingu-5 mg nokusetshenziswa kwe-vacuum extender isikhathi esiyizinyanga ezintathu. Idivayisi ye-vacuum i-PeniMaster®PRO yayisetshenziswa njenge-extender, futhi iziguli eziseqenjini lesithathu kwakudingeka zigqoke iseluleki okungenani amahora amathathu ngosuku esikhathini esiyizinyanga ezintathu.
Ukucutshungulwa kwezibalo kwedatha etholiwe kwenziwa kusetshenziswa isofthiwe ye-STATISTICA 6.0. I-hypothesis evamile yokusabalalisa ihlolwe kusetshenziswa ukuhlolwa kwe-Shapiro-Wilk. I-Mean (M) kanye nokuchezuka okujwayelekile (SD) kwanqunywa kokuhluka ngakunye okukhona okunokusabalalisa okuvamile.
Amanani we-p<0.05 abonakale ebaluleke ngokwezibalo. Ukuqhathaniswa kwamaqembu amathathu kwenziwa ngokuvumelana ne-H-score yokuhlolwa kwe-Kruskal-Wallis, futhi ku-p<0.05 ukuqhathanisa okubhangqiwe kweqembu kusetshenziswa ukuhlolwa kwe-Mann-Whitney kusetshenziswa ukulungiswa kwe-Bonferroni kwasetshenziswa. Ukuhlolwa kwe-Wilcoxon kusetshenziswe ukuhlola amandla wamapharamitha.
I-PeniMaster PRO yokwelashwa kwangemva kokuhlinzwa komdlavuza wendlala yesinye Isifundo somtholampilo 2015/2016
- Imiphumela:
- Iqembu 1: ukufinyezwa kwepipi ngemva kwezinyanga ezi-3: cishe - 1.6 cm / - 12.45%
- Iqembu 2 (elinomuthi):
Ukunciphisa ipipi ngemva kwezinyanga ezi-3: cishe - 1.2 cm / - 10.26% - Iqembu 3 (ne-PeniMaster PRO yokwandisa umthondo):
UKWAndiswa komthondo ngemva kwezinyanga ezi-3: cishe + 0.75 cm / + 5.5% - Umehluko eqenjini lobude bepipi elingu-1 (elingelashiwe) / iqembu 3 (ne-PeniMaster PRO): cishe 18%
IMIPHUMELA NENGXOXO
Ukuhlaziywa kwemiphumela yokulinganisa ubude benduku kubonise ukuthi eqenjini elilawulayo, ukwehla okumaphakathi kobude bepipi kwaba ngu-0.73±0.08 cm izinsuku ezingu-7 ngemva kokuhlinzwa, 0.95±0.06 cm ngemva kwezinsuku ezingu-30 kanye ne-1.635±0.0 ngemva kwezinyanga ezingu-3 .12 cm uma kuqhathaniswa nezilinganiso zangaphambi kokusebenza (Fig. 1) . Ukwehla kobude be-penis ezinyangeni ezi-3 ngemuva kokuhlinzwa kwakungamaphesenti angu-12.45.
Eqenjini lesibili leziguli ezithatha i-PDE-5 inhibitors, ukwehla kwesilinganiso sobude bomthondo kwaba ngu-0.75±0.08 cm ngemva kwezinsuku ezingu-7, 1.125±0.07 cm ngemva kwezinsuku ezingu-30, kanye ne-1.175±0.08 cm ngemva kwezinyanga ezingu-3 cm uma kuqhathaniswa nezilinganiso zangaphambi kokuhlinzwa ( Umfanekiso 2) . Ngokusho kwedatha etholiwe, eqenjini lesibili ukwehla kobude be-penis kwakungamaphesenti angu-10.26, okungukuthi amaphesenti angu-2.19 ngaphansi kweqembu lokulawula.
Eqenjini lesithathu leziguli, ezithole inhlanganisela yokuthatha i-PDE-5 inhibitors nokusebenzisa i-vacuum extender, ukwehla kwesilinganiso sobude be-penile ngemva kwezinsuku ze-7 kwaba ngu-0.78 ± 0.1 cm (Fig. 3) . Ngemuva kwezinsuku ezingama-30, ukwanda okuthembekile ngokwezibalo kobude bepipi obungu-0.175±0.08 cm kwabonwa, kwathi ngemuva kwezinyanga ezi-3 ukwanda kobude kwaba ngu-0.75±0.08 cm. Ngakho-ke, naphezu kokuncipha kwamaphesenti angu-5.7 ubude be-penis ezinsukwini ezingu-7, kwakukhona ukwanda kwamaphesenti angu-5.5 ubude be-penis ezinsukwini ezingu-90 uma kuqhathaniswa nesisekelo.
Lapho kuhlolwa imiphumela yokuhlolwa ngokohlu lwemibuzo lwe-IIEF-5, idatha elandelayo yatholwa: eqenjini lokuqala, inani eliphelele lobunzima bokungasebenzi kahle kwe-erectile ngaphambi kokuhlinzwa lalihambisana namaphuzu we-16.5, izinsuku eziyisikhombisa ngemva kokuhlinzwa lenyuke ngo-6.45 ±1 .3 amaphuzu, okwakuyisilinganiso samaphuzu angu-9.7 (Fig. 4) . Ukwenyuka kancane kumaphuzu angu-10.1 no-10.2, ngokulandelana, kuphawulwe ngemva kwezinsuku ezingu-30 nezingu-90.
Eqenjini lesibili, inani eliphelele lezinga le-erectile dysfunction lehle ngamaphuzu angu-6.45 ± 1.3 izinsuku ezingu-7 ngemva kokusebenza, okungukuthi amaphuzu angu-9.7 (Fig. 5) . Ngemuva kwezinsuku ezingama-30 nezingu-90, kwaba khona ukwanda kwenani eliphelele, okwakungu-13.2 no-13.4 amaphuzu, ngokulandelana. Lapho kuhlolwa inani eliphelele le-erectile dysfunction score eqenjini lesithathu, idatha etholiwe ayizange ihluke ngokwezibalo ngokuthembekile emiphumeleni etholwe eqenjini lesibili (Fig. 6) .
I-PeniMaster PRO yokwelashwa kwangemva kokuhlinzwa komdlavuza wendlala yesinye Isifundo somtholampilo 2015/2016
- Ngemva kwezinsuku ezingu-90, ukuqina kwenduku yezihloko ezingalashiwe ezivela kuQembu 1 kwakungasenamandla ngokwanele ukuhlanganyela ocansini.
- Emaqenjini 2 kanye no-3 (ne-PeniMaster PRO), izifundo zithole ukuqhanyelwa kanzima ngokwanele ukuya ocansini.
- Olunye ucwaningo lubonisa futhi ukufinyezwa kwepipi ngo-1-3 cm phakathi nonyaka ngemva kokukhishwa kwe-prostate.
- Ucwaningo lwamanje lubonisa ukuthi i-PeniMaster PRO ayigcini nje ngokugcina ubude benduku ngemva kokususwa kwe-prostate, kodwa iyayithuthukisa.
- Akukhona nje kuphela ukululama kulesi sifo, kodwa futhi nokuvuselelwa kwe-sequelae yayo kubalulekile emithini yesimanje.
- Azikho iziqondiso ezijwayelekile zokwelashwa ngemuva kokuhlinzwa kwe-prostatectomy.
Lapho kuhlolwa izinga lokuqina komthondo ngokwesilinganiso se-EHS, kwatholwa imiphumela elandelayo: izinga lokuqina kokumiswa eqenjini lokuqala ngaphambi kokuhlinzwa kwaba ngu-3.1 futhi lehla laya ku-1.22±0.2 izinsuku eziyisikhombisa ngemva kokuhlinzwa. Ngemva kwezinsuku ezingu-30 nezingu-90 kwaba yizi-2, ezihambisana nepipi eliqinile ngokwanele kodwa hhayi ipipi eliqinile ngokwanele ukuze lingene kanye nokwenza ucansi.
Idatha etholwe eqenjini lesibili nelesithathu ayizange ihluke futhi ibonakala ngokuncipha kwebanga lobulukhuni be-penile ezinsukwini zokuqala ze-7 futhi ngokuqhubekayo nokuthambekela kokwanda kuze kufike ebangeni lesi-3, okusho ukuthi ukuqina okwanele ukungena.
Izinga lempilo ngokwesilinganiso se-QOL (Ikhwalithi yokuphila) yayingamaphoyinti angu-2.1 eqenjini lokuqala ngaphambi kokuhlinzwa futhi lehla ngamaphuzu angu-2.05±0.3 ezinsukwini ezingu-7 ngemva kokuhlinzwa. Ngaphezu kwalokho, kutholwe ukuthambekela okuhle ekuthuthukisweni, ukuze izinga lokuphila elilinganiselwe libe ngamaphoyinti angu-3.7 ezinsukwini ezingu-30 nezingu-90 ngemva kokungenelela kokuhlinzwa.
Ngaphezu kwalokho, eqenjini lesibili nelesithathu, ezinsukwini ezingu-7 ngemva kokuhlinzwa, izinga lokuphila lehla laya kumaphuzu angu-4.15 futhi ngemva kwezinsuku ezingu-30 nezingu-90 lenyuka laba amaphuzu angu-2.4 eqenjini lesibili namaphuzu angu-2.6 kwelesithathu, ngokulandelana kweqembu elihlonziwe. Umehluko ofanele ngokwezibalo ngekhwalithi yokuphila eqenjini lesibili nelesithathu awutholakalanga.
Ngokusho kwezincwadi, okwamanje ayikho idatha eqinisekisayo mayelana nokusetshenziswa kwe-PDE-5 inhibitors ukuze kuvuselelwe umsebenzi wocansi emadodeni athole i-radical prostatectomy yomdlavuza wendawo we-prostate. Ngaphezu kwalokho, awukho umbono ongavumelananga ngemithamo, ubude besikhathi kanye nezikhathi zokwelashwa zokusetshenziswa kwe-PDE-5 inhibitors kulesi sigaba sesiguli.
Ngokwemiphumela yophenyo luka-A. Briganti et al. [18] ukungasebenzi kahle kwe-erectile (37%) kutholwe kaningi kakhulu eqenjini lesiguli elathola ama-PDE-5 inhibitors njalo esikhathini ngemva kokusebenza kuneqembu lokulawula (73%, p<0.001), elihambisana ngokuphelele ne idatha etholwe ngesikhathi socwaningo iyaqhathaniswa. Ukuvama kokungasebenzi kahle kwe-erectile eqenjini lokulawula ngemva kwezinyanga ezintathu kwakungamaphesenti angu-75 (iziguli ezingu-15), eqenjini lesibili amaphesenti angu-15 ngaphansi, okungukuthi amaphesenti angu-60 (iziguli ezingu-12), futhi eqenjini lesithathu amaphesenti angu-20 ngaphansi kweqembu lokulawula, okungukuthi amaphesenti angama-55 (abantu abayi-11).
Ucwaningo oluningi luye lwabonisa ukwehla kobude be-penile be-1-3 cm ngaphezu konyaka wokubhekwa ezigulini eziye zathola i-prostatectomy enkulu [19,20]. Esifundweni samanje, ukuguqulwa kobude be-penile phakathi nezinyanga ezintathu ngemva kokuhlinzwa kucatshangelwe, neqembu elilawulayo libonisa ukwehla kobude kuze kufike ku-1.64 ± 0.12 cm kanye neqembu lesibili elibonisa ukwehla okulinganiselwe ubude be-penile, okulinganiselwa ku-1.175±0.01 cm.
I-Cavernous fibrosis, eyenzeka ngenxa yokutholwa kwamaseli emisipha abushelelezi emizimbeni ye-cavernous ngemuva kokulimala kwemizwa ye-erectile, ingasolwa njengendlela engenzeka yokunciphisa usayizi wepipi.
Ucwaningo lwangaphambilini [21] lubonise ukuthi ukusetshenziswa kwe-vacuum extensions kuvumela ukulondolozwa kobude be-penile ngemva kwe-prostatectomy eqinile. Ngesikhathi esifanayo, kunombono ophikisanayo mayelana nokusetshenziswa kwe-vacuum extenders, okubheka ingozi yokuthuthukisa i-cavernosal fibrosis ngenxa yokuqala kwe-ischemia yemizimba ye-cavernous, i-acidosis kanye nokuphumula okwanele kwemisipha ebushelelezi [22]. Imiphumela etholwe ngesikhathi socwaningo lwamanje ayizange ibonise kuphela ukuthi kungenzeka ukugcina ubude bepenis ngokuhlanganisa ukuthathwa kwansuku zonke kwe-PDE-5 inhibitor kanye nokusetshenziswa kwansuku zonke kwe-vacuum extender, kodwa futhi ubude bepipi ngo-0.75± 0.01 cm ukwanda.
Esimeni samanje sokuthuthuka komphakathi, izinga lempilo liyingxenye ebalulekile nebalulekile empilweni jikelele kanye nenhlalakahle yesiguli.Izifundo eziningi ezinikelwe ekuhloleni izinga lempilo zikhombise ukubaluleka nokubalulekile kokuthuthukisa kanye nokuqalisa. uhlelo lokuvuselela isiguli. Okwamanje awekho ama-algorithms aqinile futhi anconyiwe okuvuselelwa kweziguli ngemuva kwe-radical prostatectomy enomphumela ofakazelwe [7,14,15,16,17].
I-PeniMaster PRO yokwelashwa kwangemva kokuhlinzwa komdlavuza wendlala yesinye Isifundo somtholampilo 2015/2016
- Inhlanganisela ye-PDE-5 inhibitor ne-PeniMaster PRO ivimbela ukushwabana kwenduku futhi andise ipipi ngemva kokususwa kwe-prostate.
- Ukungasebenzi kahle kwe-Erectile kufika ku-20% kuvame kakhulu ngemva kwe-prostatectomy uma kungelashwa.
- Ukungasebenzi kahle kwe-Erectile kulimaza kakhulu izinga lempilo.
ISIPHETHO
Imiphumela etholwe njengengxenye yocwaningo ivumela iziphetho ezilandelayo:
- okwamanje ayikho inqubo evamile ehlanganisiwe yokuvuselela ukusebenza kocansi ezigulini eziye zathola i-prostatectomy enkulu yomdlavuza wendawo we-prostate;
- inhlanganisela yokusetshenziswa kwansuku zonke kwe-PDE-5 inhibitors kanye nokusetshenziswa kwe-vacuum extender kuvumela hhayi kuphela ukuvimbela ukuncipha kobude bepipi, kodwa futhi ukwandisa ubude bepipi ngo-0.75±0.01 cm;
- isigameko sokungasebenzi kahle kwe-erectile ngemuva kwe-prostatectomy enkulu yi-15 kanye namaphesenti angu-20 aphansi ezigulini emaqenjini I no-II uma kuqhathaniswa neqembu lokulawula, ngokulandelana;
- isimo sokungasebenzi kahle kwe-erectile siba sibi kakhulu izinga lempilo yeziguli esikhathini sokuhlinzwa.
