1
|
Gross AJ, Rosenbaum C, Becker B, Netsch C. [Development of endoscopic enucleation of the prostate]. Aktuelle Urol 2024; 55:207-212. [PMID: 38599594 DOI: 10.1055/a-2286-1243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
This article deals with lasers from their initial description to the most advanced applications in the treatment of benign prostate enlargement.
Collapse
Affiliation(s)
- Andreas J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Germany
| | | | - Benedikt Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Germany
| | | |
Collapse
|
2
|
Kotsiris D, Tatanis V, Peteinaris A, Tzenetidis V, Pagonis K, Ntasiotis P, Adamou C, Vrettos T, Liatsikos E, Kallidonis P. Outcomes of thulium prostatectomy with "Oyster technique" versus transurethral prostatectomy (TURP): a randomized control trial. World J Urol 2023; 41:2473-2479. [PMID: 37450005 DOI: 10.1007/s00345-023-04510-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023] Open
Abstract
PURPOSE To compare the perioperative and postoperative outcomes between Oyster prostate vaporesection using Tm-YAG laser and the conventional transurethral prostatectomy using monopolar energy. METHODS Patients with LUTS with an accumulative size of at least 60 ml were randomly assigned to one of two parallel groups to undergo Tm-YAG laser vaporesection (Group 1) or conventional monopolar transurethral prostatectomy (Group 2). The primary endpoints were the reduction in IPSS and the increase in Qmax postoperatively. Secondary endpoints included the Hemoglobin drop, the complication rate, the changes in urodynamic parameters, the duration of hospitalization and catheterization and the changes in IIEF during the 24-month follow-up. RESULTS In total 32 and 30 patients were enrolled in Groups 1 and 2, respectively. Patient age (p = 0.422) and prostate volume were similar among the groups (p = 0.51). The outcomes in terms of IPSS decrease and Qmax amelioration were comparable (p = 0.449 and p = 0.237, respectively). Operative and hospitalization times were lower in Group 1 (p = 0.002 and p = 0.004, respectively). Hemoglobin drop, changes in urodynamic parameters and improvement in IIEF and QoL scores did not differ among the two Groups. The average time with the catheter was 2.06 ± 0.35 and 2.5 ± 0.82 (p = 0.003) days for Group 1 and Group 2, respectively. The overall complication rate was 6.2% for Group 1 and 13.3% for Group 2. CONCLUSIONS The Oyster technique leads to similar postoperative outcomes compared to the standard monopolar transurethral prostatectomy. The shorter catheterization, hospitalization and operation time should be considered advantages of the Oyster technique.
Collapse
Affiliation(s)
- Dimitrios Kotsiris
- Department of Urology, University Hospital of Patras, Patras, Greece
- Department of Urology, Naval and Veterans Hospital, Chania, Greece
| | - Vasileios Tatanis
- Department of Urology, University Hospital of Patras, Patras, Greece
| | | | | | | | | | | | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University Hospital of Patras, Patras, Greece
| | - Evangelos Liatsikos
- Department of Urology, University Hospital of Patras, Patras, Greece.
- Medical University of Vienna, Vienna, Austria.
| | | |
Collapse
|
3
|
Manfredi C, García-Gómez B, Arcaniolo D, García-Rojo E, Crocerossa F, Autorino R, Gratzke C, De Sio M, Romero-Otero J. Impact of Surgery for Benign Prostatic Hyperplasia on Sexual Function: A Systematic Review and Meta-analysis of Erectile Function and Ejaculatory Function. Eur Urol Focus 2022; 8:1711-1732. [PMID: 35803852 DOI: 10.1016/j.euf.2022.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/17/2022] [Indexed: 01/25/2023]
Abstract
CONTEXT Several sexual side effects, including erectile, ejaculatory, and orgasmic dysfunction, were reported with the majority of surgical procedures for benign prostatic obstruction (BPO). OBJECTIVE To systematically review current evidence regarding the impact of benign prostatic hyperplasia (BPH) surgery on sexual function. EVIDENCE ACQUISITION A comprehensive bibliographic search on the MEDLINE, Cochrane Library, Embase, Web of Science, and Google Scholar databases was conducted in July 2021. The population, intervention, comparator, and outcome (PICO) model was used to define study eligibility. Studies were Included if they assessed patients with BPO and related lower urinary tract symptoms (P) undergoing BPH surgery (I) with or without a comparison between surgical treatments (C) evaluating the impact on sexual function (O). Retrospective and prospective primary studies were included. A pooled analysis was conducted on studies including the postoperative assessment of International Index of Erectile Function (IIEF)-5, Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD; Function and/or Bother), or retrograde ejaculation (RE) rate (PROSPERO database ID: CRD42020177907). EVIDENCE SYNTHESIS A total of 151 studies investigating 20 531 patients were included. Forty-eight randomized controlled trials evaluating 5045 individuals were eligible for the meta-analysis. In most studies (122, 80.8%), only erectile and/or ejaculatory function was evaluated. A substantial number of articles (67, 44.4%) also used nonvalidated tools to evaluate erectile and/or ejaculatory function. The pooled analysis showed no statistically significant changes in IIEF-5 score compared with baseline for the transurethral resection of the prostate (TURP; weighted mean difference [WMD] 0.76 pts; 95% confidence interval [CI] -0.1, 1.62; p = 0.08), laser procedure (WMD 0.33 pts; 95% CI -0.1, 0.77; p = 0.13), and minimally invasive treatment (WMD -1.37 pts; 95% CI -3.19, 0.44; p = 0.14) groups. A statistically significantly higher rate of RE was found after TURP (risk ratio [RR] 13.31; 95% CI 8.37, 21.17; p < 0.00001), other electrosurgical procedures (RR 34.77; 95% CI 10.58, 127.82; p < 0.00001), and the entire laser group (RR 17.37; 95% CI 5.93, 50.81; p < 0.00001). No statistically significant increase in RE rate was described after most of the minimally invasive procedures (p > 0.05). The pooled analysis of MSHQ-EjD scores was possible only for prostatic urethral lift, showing no statistically significant difference between baseline and post-treatment MSHQ-EjD Function scores (WMD -0.80 pts; 95% CI -2.41, 0.81; p = 0.33), but postoperative MSHQ-EjD Bother scores were significantly higher (WMD 0.76 pts; 95% CI 0.22, 1.30; p = 0.006). CONCLUSIONS Erectile function appears to be unaffected by most surgical procedures for BPO. RE is a very common adverse event of BPH surgery, although emerging minimally invasive surgical procedures could be associated with a lower risk. PATIENT SUMMARY Benign prostatic hyperplasia surgery can have an impact on sexual function, mainly involving ejaculatory function.
Collapse
Affiliation(s)
- Celeste Manfredi
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Borja García-Gómez
- Department of Urology, Hospital Universitario 12 Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain; ROC Clinic, Madrid, Spain
| | - Davide Arcaniolo
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Esther García-Rojo
- Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain; ROC Clinic, Madrid, Spain
| | - Fabio Crocerossa
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Riccardo Autorino
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | - Christian Gratzke
- Department of Urology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Marco De Sio
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Javier Romero-Otero
- Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain; ROC Clinic, Madrid, Spain.
| |
Collapse
|
4
|
Kobayashi Y, Arai H, Honda M. Influence of transurethral enucleation with bipolar of the prostate on erectile function: Prospective analysis of 51 patients at 12-month follow-up. PLoS One 2022; 17:e0272652. [PMID: 35951591 PMCID: PMC9371260 DOI: 10.1371/journal.pone.0272652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 07/25/2022] [Indexed: 11/20/2022] Open
Abstract
Background Transurethral enucleation with bipolar (TUEB) is a safe and effective surgery for benign prostatic obstruction (BPO). However, few data exist concerning the influence of TUEB on erectile function (EF) in patients with BPO. Objective To evaluate the influence of TUEB on EF in patients with BPO at 3- and 12-month follow-up. Material and methods We prospectively enrolled 51 patients who underwent TUEB from June 2016 to April 2020. We evaluated maximum urinary flow rate (Qmax), postvoid residual urine (PVR), International Prostate Symptom Score (IPSS), quality of life (QoL), and International Index of Erectile Function-5 (IIEF-5) preoperatively and at 3- and 12-month follow-up. We classified the patients according to their preoperative IIEF-5 score into group 1 (IIEF-5 ≥10; n = 24) and group 2 (IIEF-5 <10; n = 27), and for further evaluation of EF, into subgroups a: severe (IIEF-5 5–7), b: moderate (8–11), c: mild to moderate (12–16), d: mild (17–21), and e: no erectile dysfunction (22–25). Data are displayed as median or median (interquartile range). Results The study comprised 51 patients with a median age of 75 (70.5–79.5) years. Median prostate and transition zone volumes were 69.5 (46.5–78.8) mL and 30.5 (19–43) mL, respectively. Urinary function improved significantly when comparing respective preoperative, 3-month, and 12-month follow-up values: Qmax (7.6, 12.9, 15.2 mL/s), PVR (50, 0, 0 mL), IPSS (20.5, 9, 6), and QoL (5, 2, 2), respectively. There was no significant change in IIEF-5 score across the three time points: 9, 7, 8. The IIEF-5 score slightly but significantly increased between the preoperative and 12-month follow-up values in group 2 (5, 5, 6) and subgroup a (5, 5, 5). Conclusion TUEB was effective and safe surgery for patients with BPO and showed no significant influence on EF at 12-month follow-up after TUEB in patients with BPO.
Collapse
Affiliation(s)
- Yasuyuki Kobayashi
- Department of Urology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami, Hyogo, Japan
- * E-mail:
| | - Hiroki Arai
- Department of Urology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami, Hyogo, Japan
| | - Masahito Honda
- Department of Urology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami, Hyogo, Japan
| |
Collapse
|
5
|
Li B, Hao L, Pang K, Zang G, Wang J, Yang C, Zhang J, Cai L, Wang X, Han C. Assessment of Sexual Outcomes in Patients Undergoing Thulium Laser Prostate Surgery for Management of Benign Prostate Hyperplasia: A Systematic Review and Meta-analysis. Sex Med 2022; 10:100483. [PMID: 35045372 PMCID: PMC9023247 DOI: 10.1016/j.esxm.2021.100483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022] Open
Abstract
Background Thulium laser (Tm:YAG) prostate surgery is a safe and effective procedure with low morbidity and comparable clinical outcomes to those of transurethral resection of the prostate (TURP). However, the sexual function outcomes (erectile and ejaculatory function) have been scarcely studied. Aim We aimed to assess the impact of Tm:YAG prostate surgery on sexual outcomes (erectile and ejaculatory function) and compare them with those patients undergoing TURP. Material and Methods We searched digital databases like PUBMED, SCOPUS, CENTRAL and EMBASE using relevant keywords to identify comparative studies on TURP and non-comparative studies on Tm:YAG prostate surgery that assessed sexual outcomes. We performed qualitative and quantitative analyses with the extracted data. We carried out a meta-analysis to compare postoperative International Index of Erectile Function (IIEF-5) scores and incidences of retrograde ejaculation (RE) in patients undergoing either Tm:YAG or TURP. The pre-operative and post-operative IIEF-5 scores were pooled to estimate overall scores. Results We included 5 comparative and 8 non-comparative studies in this review. We found the postoperative IIEF-5 score improvements to be significantly higher in the Tm:YAG prostate surgery group than in the TURP group with a significant mean difference (MD) of 0.45 (95% CI, 0.18 to 0.72; P = .001). We found no significant associations between the procedures. The pooled OR for the association of RE was estimated at 0.90 (95% CI, 0.50 to 1.60; P = .71; I2 = 0%). Conclusion Tm:YAG prostate surgery improves erectile function more than TURP, according to our findings. Tm:YAG prostate aided surgery also outperforms TURP in terms of preserving sexual function following surgery.However, We found similar or no difference in incidence of RE between Tm:YAG prostate surgery and TURP. Bibo L, Hao L, Pang K, et al. Assessment of Sexual Outcomes in Patients Undergoing Thulium Laser Prostate Surgery for Management of Benign Prostate Hyperplasia: A Systematic Review and Meta-analysis. Sex Med 2022;10:100483.
Collapse
Affiliation(s)
- Bibo Li
- Department of Chest Disease Center, Zhejiang Rongjun hospital, Zhejiang Province, China
| | - Lin Hao
- Xuzhou Central Hospital, Xuzhou, China
| | - Kun Pang
- Xuzhou Central Hospital, Xuzhou, China
| | | | - Jian Wang
- Xuzhou Central Hospital, Xuzhou, China
| | - Chendi Yang
- Suzhou Hospital of Chinese Medicine, Suzhou, China
| | - Jianjun Zhang
- Suqian People's Hospital of Nanjing Drum-Tower Hospital Group, the Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, China
| | - Longjun Cai
- Suqian People's Hospital of Nanjing Drum-Tower Hospital Group, the Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, China
| | | | | |
Collapse
|
6
|
Reasons to go for thulium-based anatomical endoscopic enucleation of the prostate. World J Urol 2021; 39:2363-2374. [PMID: 33948694 DOI: 10.1007/s00345-021-03704-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 04/17/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To summarize the current evidence and the reasons to go for thulium-based anatomical endoscopic enucleation of the prostate (AEEP). METHODS This review discusses the available literature on thulium-based AEEP. RESULTS Thulium lasers operate at a wavelength between 1940 and 2013 nm. This wavelength, which has a low penetration depth in water, allows to perform smooth cuts in the prostatic tissue and allows urologists to perform various procedures: resection, vaporization, enucleation, or vapoenucleation of the prostate. Depending on the type of thulium laser, it can be used either in a continuous, or pulsed mode. CONCLUSION In recent years, an increasing amount of evidence has described the thulium laser as a minimally invasive and size-independent treatment option for benign prostatic enlargement with excellent long-term results.
Collapse
|
7
|
Maruccia S, Fulgheri I, Montanari E, Casellato S, Boeri L. Nomenclature in thulium laser treatment of benign prostatic hyperplasia: it's time to pull the rabbit out of the hat. Lasers Med Sci 2021; 36:1355-1367. [PMID: 33389305 DOI: 10.1007/s10103-020-03227-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/16/2020] [Indexed: 12/14/2022]
Abstract
We performed a narrative review with the focus on laser settings and surgical procedure with thulium laser. Our primary goal was to define the most valid settings of each surgical procedure to overcome the inconsistency about nomenclature of thulium surgery and to ensure comparability of future publications. A literature search of articles on thulium laser treatment of benign prostatic hyperplasia (BPH) was conducted between 2009 and 2019. We proposed a new classification standard for laser settings and associated surgical procedure. Each article was analyzed and categorized as concordant or discordant referring to the new classification. In total, 74 papers were included in this narrative review. Overall, 43% and 42% of included studies reported discordant laser parameters and surgical description, respectively. Most of the studies on vaporization were categorized as discordant because they reported a medium/low laser setting instead of high power. Conversely, 93.3% of studies on enucleation were deemed as discordant for laser setting because they reported high power parameters instead of medium-low power setting. Most of the studies on laser enucleation and vapo/enucleation were considered discordant for surgical procedure since authors did not mention the use of mechanical vs. laser method for enucleation. The current literature lacks a uniform definition and standardization of the terminology of thulium laser settings and surgical techniques to guarantee comparability between different approaches. We found a huge heterogeneity in 10 years of surgery with thulium laser. We proposed a new classification of laser setting and procedural description for categorization of thulium laser surgery for BPH.
Collapse
Affiliation(s)
- Serena Maruccia
- Department of Urology, Istituti Clinici Zucchi, Monza, Italy
| | - Irene Fulgheri
- Department of Pharmacy, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | | | - Luca Boeri
- Department of Urology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy.
| |
Collapse
|
8
|
Liu Y, Cheng Y, Zhuo L, Liu K, Xiao C, Zhao R, Lu J, Ma L. Impact on Sexual Function of Endoscopic Enucleation vs Transurethral Resection of the Prostate for Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: A Systematic Review and Meta-Analysis. J Endourol 2020; 34:1064-1074. [PMID: 32242462 DOI: 10.1089/end.2020.0141] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Although the transurethral resection of the prostate (TURP) has been regarded as the gold standard surgical option for lower urinary tract symptoms due to benign prostatic hyperplasia, the endoscopic enucleation of the prostate (EEP) with novel techniques is also recommended. However, whether there are differences on male sexual functions after these two procedures is still controversial. We performed this meta-analysis to investigate the impact on erectile function (EF) and ejaculation of EEP and TURP, and to explore the potential superiority between these two approaches. Materials and Methods: Literature search was conducted on Medline, Embase, and the Cochrane library, to obtain all relevant randomized controlled trials published before December 13, 2018. Outcome data were pooled and analyzed with Review Manager 5.3 to compare the International Index of Erectile Function 5 (IIEF-5) scores and retrograde ejaculation (RE) rates from short- to long-term follow-ups. Results: Ten articles with 1435 patients were included. EEP group showed higher IIEF-5 scores than TURP group with mean difference (MD) = 1.00, confidence interval (95% CI): 0.95-1.05 at 48 months and MD = 1.08, 95% CI: 1.03-1.13 at ≥60 months, respectively. In subgroup analysis, the holmium laser enucleation of the prostate showed significantly better IIEF scores than TURP group at 48 months (MD = 1.00, 95% CI: 0.95-1.05) and ≥72 months (MD = 1.08, 95% CI: 1.03-1.13). Additionally, no significant difference in RE rate was found between EEP and TURP (risk ratio = 1.02, 95% CI: 0.85-1.23). Conclusions: Compared with TURP, EEP may produce a more durable benefit for postoperative preservation of EF at long-term stage.
Collapse
Affiliation(s)
- Yuqing Liu
- Department of Urology and Peking University Third Hospital, Beijing, China
| | - Yinchu Cheng
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Lin Zhuo
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Ke Liu
- Department of Urology and Peking University Third Hospital, Beijing, China
| | - Chunlei Xiao
- Department of Urology and Peking University Third Hospital, Beijing, China
| | - Rongsheng Zhao
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Jian Lu
- Department of Urology and Peking University Third Hospital, Beijing, China
| | - Lulin Ma
- Department of Urology and Peking University Third Hospital, Beijing, China
| |
Collapse
|
9
|
Castellani D, Pirola GM, Pacchetti A, Saredi G, Dellabella M. State of the Art of Thulium Laser Enucleation and Vapoenucleation of the Prostate: A Systematic Review. Urology 2020; 136:19-34. [DOI: 10.1016/j.urology.2019.10.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 02/06/2023]
|
10
|
Enikeev D, Glybochko P, Rapoport L, Okhunov Z, O'Leary M, Potoldykova N, Sukhanov R, Enikeev M, Laukhtina E, Taratkin M. Impact of endoscopic enucleation of the prostate with thulium fiber laser on the erectile function. BMC Urol 2018; 18:87. [PMID: 30314492 PMCID: PMC6186032 DOI: 10.1186/s12894-018-0400-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/02/2018] [Indexed: 11/16/2022] Open
Abstract
Background The impact of number of endoscopic enucleation of the prostate techniques (holmium laser enucleation - HoLEP for example) on erectile function have already been investigated. However, the thulium-fiber laser, in this setting remains unstudied. In this study, we compared sexual function outcomes in patients with benign prostatic hyperplasia (BPH) treated with transurethral resection of the prostate (TURP) or thulium-fiber laser enucleation (ThuFLEP). Methods We performed a retrospective analysis of patients who underwent transurethral resection and endoscopic enucleation of the prostate for BPH; inclusion criteria was the presence of infravesical obstruction (IPSS > 20, Qmax < 10 mL/s). Erectile function (EF) was assessed using the International Index of Erectile Function (IIEF-5) both prior to endoscopic examination, and six months after. Results A total of 469 patients with BPH were included in the study; of these, 211 underwent to ThuFLEP, and 258 TURP. Preoperative IIEF-5 in TURP and ThuFLEP groups were 11.7 (±4.5) and 11.1 (±5.0), respectively (p = 0.17). At six month the IIEF-5 score was unchanged (p = 0.26 and p = 0.08) and comparable in both groups (p = 0.49). However, mean IIEF-5 score shown significant increase of 0.72 in ThuFLEP group, comparing to decrease of 0.24 in TURP patients (p < 0.001). Conclusions Both TURP and ThuFLEP are effective modalities in the management of infravesical obstruction due to BPH. At six months follow-up after surgery, both techniques lead to comparable IIEF-5 score. However, our results demonstrated that the ThuFLEP is more likely to preserve the erectile function leading to increase of IIEF-5 at six months in contrast to TURP which lead to slight drop in IIEF-5 score.
Collapse
Affiliation(s)
- Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
| | - Petr Glybochko
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Leonid Rapoport
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine; Orange, CA, USA
| | - Mitchel O'Leary
- Department of Urology, University of California, Irvine; Orange, CA, USA
| | - Natalya Potoldykova
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Roman Sukhanov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Mikhail Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Ekaterina Laukhtina
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| |
Collapse
|
11
|
Borchert A, Leavitt DA. A Review of Male Sexual Health and Dysfunction Following Surgical Treatment for Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms. Curr Urol Rep 2018; 19:66. [PMID: 29923036 DOI: 10.1007/s11934-018-0813-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Review how the various surgical treatments for benign prostatic hyperplasia and lower urinary tract symptoms impact on male sexual health and function. RECENT FINDINGS The interplay between benign prostatic hyperplasia and erectile function is complex, and the conditions seem linked. Most cavitating procedures to improve male voiding will degrade ejaculatory and possibly erectile function. Many of the newer minimally invasive therapies appear to preserve sexual function in the short term while sacrificing some of the voiding improvements realized with more complete removal of the prostate adenoma. Benign prostatic hyperplasia will affect the majority of men at some point in life, and surgical treatment remains an integral option for managing the associated urinary symptoms. These treatments are associated with variable rates of sexual side effects, including ejaculatory, erectile, and orgasmic dysfunction. As the impact of these treatment modalities on sexual dysfunction has become more widely acknowledged, there has been a rise in interest in modalities that minimize adverse sexual side effects. Recent studies have sought to further elucidate the relationship between surgical treatment of benign prostate hyperplasia and sexual outcomes, and a number of studies have demonstrated that treatment of benign prostate hyperplasia can actually result in improved sexual function for some patients. This work intends to review the proposed pathophysiology behind the sexual side effects resulting from the surgical treatment of benign prostate hyperplasia and review the literature regarding both established and emerging surgical techniques.
Collapse
Affiliation(s)
- Alex Borchert
- Vattikuti Urology Institute, Henry Ford Hospital, Henry Ford Health System, 2799 West Grand Boulevard, K9, Detroit, MI, 48202, USA
| | - David A Leavitt
- Vattikuti Urology Institute, Henry Ford Hospital, Henry Ford Health System, 2799 West Grand Boulevard, K9, Detroit, MI, 48202, USA.
| |
Collapse
|
12
|
Longitudinal changes in erectile function after thulium:YAG prostatectomy for the treatment of benign prostatic obstruction: a 1-year follow-up study. Lasers Med Sci 2017; 32:1517-1523. [PMID: 28685201 DOI: 10.1007/s10103-017-2273-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 06/20/2017] [Indexed: 10/19/2022]
Abstract
This study aimed to evaluate the impact of thulium:yttrium-aluminum-garnet (Tm:YAG) (RevoLix®) laser prostatectomy for the treatment of benign prostatic obstructions on erectile function (EF). A total of 208 patients who underwent Tm:YAG laser prostatectomies participated in this study. All cases were evaluated preoperatively and at 3, 6, and 12 months postoperatively using the International Prostate Symptom Score (IPSS), quality of life (QoL) score, and the International Index of Erectile Function (IIEF-5) questionnaires. Patients were divided into groups A (severe erectile dysfunction [ED]), B (moderate ED), and C (mild-to-normal ED), according to their IIEF-5 scores. The median patient ages were 69, 65, and 62 years in groups A, B, and C, respectively. Significant improvements occurred in the IPSS and QoL score within the groups during the 12-month follow-up period. The IIEF-5 scores at 3 months postoperatively were lower than the preoperative scores in groups B and C. The IIEF-5 scores subsequently improved during the 12-month follow-up period. The slope of the relationship between the IIEF-5 score and the time since Tm:YAG laser prostatectomy had a ß value of 0.2210 (95% confidence interval 0.103 to 0.338, p = 0.0003); hence, each postoperative month was associated with an increase of 0.2210 in the IIEF-5 score. The IIEF-5 scores gradually increased and reached the preoperative levels by the 12-month follow-up assessment. Although the IIEF-5 score dropped significantly during the first 3 months postoperatively, it improved over the following 12 months. Tm:YAG laser prostatectomy did not impact on EF ultimately.
Collapse
|
13
|
The Impact of Medical and Surgical Treatment for Benign Prostatic Hypertrophy on Erectile Function. Curr Urol Rep 2015; 16:80. [PMID: 26438220 DOI: 10.1007/s11934-015-0549-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There is a well-known link between treatment for lower urinary tract symptoms (LUTS) and erectile dysfunction. Surgical and medical management of LUTS all have side effect profiles which may affect erectile dysfunction, ejaculatory dysfunction, or libido. These should be taken into consideration during patient counseling. This article reviews the common side effects of the medical and surgical treatments of LUTS.
Collapse
|
14
|
Hong K, Liu YQ, Lu J, Xiao CL, Huang Y, Ma LL. Efficacy and safety of 120-W thulium:yttrium-aluminum-garnet vapoenucleation of prostates compared with holmium laser enucleation of prostates for benign prostatic hyperplasia. Chin Med J (Engl) 2015; 128:884-9. [PMID: 25836607 PMCID: PMC4834003 DOI: 10.4103/0366-6999.154282] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND This study compared the efficacy and safety between 120-W thulium:yttrium-aluminum-garnet (Tm:YAG) vapoenucleation of prostates (ThuVEP) and holmium laser enucleation of prostates (HoLEP) for patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). METHODS A retrospective analysis of 88 consecutive patients with symptomatic BPH was carried out, who underwent either 120-W ThuVEP or HoLEP nonrandomly. Patient demographics and peri-operative and 12-month follow-up data were analyzed with the International Prostate Symptom Score (IPSS), quality of life (QoL) score, maximum flow rate (Qmax), postvoid residual urine volume (PVR), and rates of peri-operative and late complications. RESULTS The patients in each group showed no significant difference in preoperative parameters. Compared with the HoLEP group, patients in the 120-W ThuVEP group required significantly shorter time for laser enucleation (58.3 ± 12.8 min vs. 70.5 ± 22.3 min, P = 0.003), and resulted in a significant superiority in laser efficiency (resected prostate weight/laser enucleation time) for 120-W Tm:YAG laser compared to holmium:YAG laser (0.69 ± 0.18 vs. 0.61 ± 0.19, P = 0.048). During 1, 6, and 12 months of follow-ups, the procedures did not demonstrate a significant difference in IPSS, QoL score, Qmax, or PVR (P > 0.05). Mean peri-operative decrease of hemoglobin in the HoLEP group was similar to the ThuVEP group (17.1 ± 12.0 g/L vs. 15.2 ± 10.1 g/L, P = 0.415). Early and late incidences of complications were low and did not differ significantly between the two groups of 120-W ThuVEP and HoLEP patients (P > 0.05). CONCLUSIONS 120-W ThuVEP and HoLEP are potent, safe and efficient modalities of minimally invasive surgeries for patients with LUTS due to BPH. Compared with HoLEP, 120-W ThuVEP offers advantages of reduction of laser enucleation time and improvement of laser efficiency.
Collapse
Affiliation(s)
| | - Yu-Qing Liu
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | | | | | | | | |
Collapse
|
15
|
|
16
|
Netsch C, Bach T, Herrmann TRW, Gross AJ. Update on the current evidence for Tm:YAG vapoenucleation of the prostate 2014. World J Urol 2014; 33:517-24. [PMID: 25300823 DOI: 10.1007/s00345-014-1417-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 09/30/2014] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION To evaluate the current role of thulium vapoenucleation of the prostate (ThuVEP) for the treatment of benign prostatic obstruction (BPO). METHODS A Medline search for randomized trials, case series, and comparative studies being published since the initial description of the ThuVEP procedure (2009-2014) was performed to assess the safety, the perioperative morbidity, the efficacy, and the durability of the technique. RESULTS A total of 14 peer-reviewed original articles, seven case series [level of evidence (LOE) 4] and seven comparative studies (LOE 3b), have been identified. ThuVEP has been shown to be a size-independent, safe, efficacious, and durable procedure for the treatment of BPO in large, prospective, and retrospective series (LOE 4/3b). The feasibility and safety of the ThuVEP procedure has also been confirmed in patients at high cardiopulmonary risk on oral anticoagulants (LOE 4). It has also been demonstrated that the erectile function is not impaired by the ThuVEP procedure (LOE 4). However, published ThuVEP series are from very few centers of excellence not exceeding a LOE of 3b. Randomized controlled trials comparing ThuVEP with standard procedures for the treatment of BPO, namely transurethral resection of the prostate, open prostatectomy, or holmium laser enucleation of the prostate, have not been published so far. CONCLUSIONS ThuVEP appears to be a size-independent, safe, efficacious, and durable procedure for the treatment of BPO (LOE 4/3b). Multicentric PRT are however needed to define the current role of ThuVEP in the armamentarium of minimally invasive transurethral surgery of the prostate.
Collapse
Affiliation(s)
- C Netsch
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany,
| | | | | | | |
Collapse
|