Effect of transurethral resection of the prostate on erectile function: a prospective comparative study

Double Trouble: An Unusual Presentation of Bilateral Penile Fracture

A penile fracture results from the rupture of the tunica albuginea due to blunt trauma to an erect penis and is a rare urological emergency. Double penile fractures involving both corpora cavernosa injuries are extremely uncommon. We report the case of a 38-year-old male who experienced acute penile pain, swelling, and a "cracking" sound during sexual intercourse. Examination and ultrasound confirmed bilateral tunica albuginea ruptures and hematoma. The surgical repair involved hematoma evacuation and suturing of the tears. The patient recovered without complications. This case highlights the necessity for prompt recognition and surgical intervention in double penile fractures to prevent long-term complications and ensure optimal recovery.

Bicentric retrospective study comparing the postoperative outcomes of patients treated surgically for bladder stones with or without concomitant surgery for BPH

PURPOSE

To compare the postoperative outcomes of male patients who underwent bladder stone (BS) removal, with or without concomitant benign prostatic hyperplasia (BPH) surgery.

PATIENTS AND METHODS

All men aged > 50 years who underwent BS removal at two French university hospitals between 2009 and 2018 were retrospectively reviewed. Four binary outcome criteria were identified during the follow-up: early postoperative complications, stone recurrence, subsequent surgery for BS or BPH, and late surgical complications. A composite score ranging from 0 to 4 was calculated by combining the four criteria.

RESULTS

A median follow-up period of 42 months was observed in 179 patients. Of these, 107 patients were in the "concomitant surgical treatment" (CST) group and 72 in the bladder "stone removal alone" (SRA) group. The CST group presented higher baseline post-void residual volume (105 vs. 30 ml, p = 0.005). Patients who underwent CST had a significantly lower rate of BS recurrence (12% vs. 39%; p = 0,001) and underwent fewer subsequent surgeries (14% vs. 44%; p < 0.001). There was no significant difference in the early (51% vs. 35%, p = 0,168) and late (26% vs. 17%, p = 0,229) complications rates between the two groups. A better composite score was observed in the CST than in the SRA, but the difference was not significant (3.07 vs. 2.72, p = 0.078).

CONCLUSION

As CST increases morbidity and decreases the risk of reoperation, each situation should be considered, taking into account patient choice and comorbidities.

Clinical practice guideline for transurethral plasmakinetic resection of prostate for benign prostatic hyperplasia (2021 Edition)

Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018, we issued the guideline "2018 Standard Edition". However much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines, so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative, intraoperative, and postoperative) of TUPKP in the treatment of BPH, postoperative complications and the level of surgeons' surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH, and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak, or in the form of an ungraded consensus-based statement. Finally, we issued 36 statements. Among them, 23 carried strong recommendations, and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP, precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention, and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (< 80 ml) and large-volume (≥ 80 ml) BPH compared with transurethral urethral resection prostate, transurethral plasmakinetic enucleation of prostate and open prostatectomy; the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing, the time indwelling catheters are needed, principles of postoperative therapeutic use of antibiotics, follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence, postoperative leukocyturia, the treatment measures for the perforation and extravasation of the capsule, transurethral resection syndrome, postoperative bleeding, urinary catheter blockage, bladder spasm, overactive bladder, urinary incontinence, urethral stricture, rectal injury during surgery, postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons' skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.

Monopolar transurethral resection of the prostate using water as the irrigation fluid: Our initial experience

Background

Monopolar transurethral resection of the prostate (M-TURP) has been the gold standard of surgical intervention in patients with benign prostatic hyperplasia with the indication for surgery. This can be achieved using varieties of irrigation fluids.

Objectives

To document our experience with M-TURP using water as irrigation fluid in 123 consecutive patients.

Materials and Methods

A retrospective study of all patients who had M-TURP with water as irrigation fluid was performed between January 2017 and July 2019. Information retrieved from theatre records and case notes includes patient's socio-demographic data, indications for surgery, intra-operative findings, the volume of resected chips and irrigation fluid used, post-operative complications and patient's satisfaction with the outcome of the procedure. These data were analysed using SPSS version 23.

Results

Data from 123 patients were analysed and presented. The age range was 44-96 years with a mean of 69 years. Prostate volume ranges from 13.9 to 276.00 mls with a mean of 95.69 mls while resected prostate volume ranges from 2.0 to 158.0 mls with a mean of 56.68 mls. Volume of the sterile water used as irrigation fluid ranged from 5.0 L to 174.0 L with a mean of 68.7 L. Mean reduction in International Prostate Symptoms Score, improvement in Q-max and reduction in post-void residual urine were 22.1, 16.9 and 141.6 mls, respectively. Transfusion rate was 6.5% while the duration of admission ranges from 1 to 6 days, with a mean of 2.5 days. The overall complication rate was 26.0%. Ninety-six percent were satisfied with the outcome.

Conclusion

M-TURP using water as irrigation fluid is safe and is as good as using the more rather expensive glycine or normal saline in bipolar TURP.

COVID-19 and Male Sexual Functioning: A report of 3 Recovered Cases and Literature Review

COVID-19 is a new global pandemic. It can affect multiple body systems and functions. However, the relationship between COVID-19 and male sexual activity did not yet get much consideration. Herein, we report the impact of COVID-19 on sexual function in 3 men who recovered from the disease. Compared with their condition before catching the infection, the men showed, in different degrees, a decline in all aspects of sexual function as assessed by the international index of erectile function. They started to develop premature ejaculation or exacerbate an already existing condition according to the premature ejaculation diagnostic tool scoring. Beck’s depression inventory revealed deterioration of the men’s moods up to severe depression. The sex-related hormones (testosterone-total and free, luteinizing hormone, follicle-stimulating hormone, prolactin, and estradiol) of these men were within normal levels. To the best of our knowledge, this is the first case report documenting deleterious changes in mood and several aspects of sexual functioning in males after recovery from the COVID-19 using validated measurement tools. Follow-up and psychological support of the recovered men may help mend their moods and consequently upgrade their sexual functioning.

Can surgical treatment for benign prostatic hyperplasia improve sexual function? A systematic review

INTRODUCTION

Erectile dysfunction is an established, well known risk of any operative management of benign prostatic hyperplasia (BPH). However, there are some cases reported in which surgical treatment has paradoxically improved erectile function. Here, we present a systematic review of the literature pertaining to the effect of surgery on sexual function, focusing on reports of improvement in erectile function following surgery.

MATERIALS AND METHODS

We searched PUBMED, EMBASE, Web of Knowledge, and SCOPUS databases for the following keywords: (("sexual function" OR "erectile function") AND "improvement" AND "benign prostatic hyperplasia" AND "surgery").

RESULTS

Sixteen studies (total n = 2087) were reviewed which reported a significant improvement in any aspect of erectile function. Ten of these studies had a follow-up period of 12 months or more while five had a follow up less than 12 months. Various surgical methods were included in the 16 studies; however, five reported TURP outcomes specifically. Eleven studies reported outcomes using the International Index of Erectile Function (IIEF). Overall, a further 87 studies showed no significant change and 8 studies showed a significant reduction.

CONCLUSIONS

The majority of studies report no change in erectile function following surgical intervention for BPH. There seems to be no obvious correlating factor between the studies reporting an improvement in erectile function. Further research is needed to guide us in how to consent our patients for erectile function outcomes for BPH surgery.

Assessment of posterior urethra in benign prostatic hyperplasia and after its surgery

Introduction:

Surgical management of benign prostatic hyperplasia (BPH) primarily consists of transurethral resection of the prostate (TURP). Due to BPH and after surgical intervention, anatomic variations in the posterior urethra are expected. Due to the paucity of information regarding posterior urethral anatomic variations in these conditions and its aftermath, this study was undertaken to evaluate the anatomic variations in the posterior urethra after TURP.

Materials and Methods:

This prospective observational study was conducted over 2 years at the Department of Surgery and Radiodiagnosis, University College of Medical Sciences, Delhi. All consenting patients undergoing TURP for BPH were included in the study. We assessed the posterior urethral changes in BPH before and 3 months after the procedure. Diagnostic modalities used were urethrocystoscopy, micturating cystourethrogram, and retrograde urethrogram. Furthermore, the prostate volume and postvoid residual volume of urine were compared before and after its surgery using ultrasonography. Urodynamic studies were used to calculate total voided volume (TVV), peak flow rate (PFR), voiding time (VT), and hesitancy.

Results:

Mean age of the patients was 68.12 ± 7.83 years. Lengthening in posterior urethra was seen in BPH patients with a mean of 4.24 ± 1.012 cm. Postprocedure, there was a mean reduction of 2.6 ± 1.225 cm in length of the posterior urethra (P < 0.0001). Prostatic urethral angle was increased in patients suffering from BPH, and it decreased after undergoing surgical management (P < 0.679). All patients enrolled in our study had prostatic lobes enlargement, and after surgery, this enlargement was reduced in most of the patients with 21 having no prostatic enlargement, and in four patients, bilateral lateral lobe was not completely reduced (P = 1.000). Stricture in prostatic urethra was observed in 2 out of 25 (8%) patients operated for BPH. Evaluation of various parameters of urodynamic studies revealed the net improvement in the TVV of 157.746 ± 120.999 ml, as before the procedure, this value was 176.715 ± 72.272 ml, and after surgery, it was 334.46 ± 78.588 ml (P < 0.001). VT taken by patients before surgery was 57.377 ± 16.858 s, and postprocedure, this value was 33.31 ± 8.807 s. This net reduction of 24.069 ± 14.88 s was statistically significant (P < 0.0001). PFR before the procedure was 6.177 ± 3.5067, and postprocedure, this value was 26.43 ± 7.112 ml/s with a net improvement of 20.253 ± 9.226 ml/s (P < 0.0001). Hesitancy in BPH patients before the procedure was 23.908 ± 15.521 s. Postprocedure, hesitancy decreased to a value of 6.79 ± 4.435 s with a net reduction of mean 17.115 ± 15.817 s (P < 0.002).

Conclusion:

By our findings, we conclude that BPH is associated with anatomic variations in posterior urethra such as lengthening of the length of the posterior urethra and increased posterior urethral elevation, which is measured by an increase in posterior urethral angle (PUA). Whereas post-TURP, there is a shortening of posterior urethra, decrease in PUA, decrease in prostatic volume, postvoid residual urine volume, and improvement in uroflowmetric parameters.

Investigation of prostate resected weight on postoperative sexual dysfunction following transurethral resection of prostate surgery: a population-based study

Background

Benign prostate hyperplasia, a common disease in elderly men, can be surgically treated with transurethral resection of the prostate (TURP). Postoperative sexual dysfunction is a major issue and is influenced by many factors. The present study aimed to assess whether the intraoperative resected prostate weight influences the probability of postoperative sexual dysfunction.

Methods

This population-based study included 41,574 patients from the Nation Health Insurance Research Database who had undergone TURP once between 1997 and 2013. All patients were divided into three groups according to the resected prostate weight (low, medium, and high groups). Perioperative risk factors influencing sexual function were analyzed. The chi-squared test and Fisher's exact test were used to analyze differences in demographic data. The Cox proportional hazard regression analysis was used to analyze the HRs. All statistical analyses were two-sided, and a P-value <0.05 was considered statistically significant.

Results

Of the 41,574 patients, 1,168 had postoperative sexual dysfunction after surgery. The incidence was not significantly different among the three resected prostate weight groups. Younger patients and patients with histories of chronic renal disease, ischemic heart disease, and obesity had higher prevalence of postoperative sexual dysfunction. Additionally, the onset time of sexual dysfunction was not significantly different among the three resected prostate weight groups.

Conclusion

Among patients undergoing TURP in Taiwan, the resected prostate weight does not seem to be related to the presence or onset time of postoperative sexual dysfunction.

[Sexual consequences of BPH treatments]

OBJECTIVE

To review the literature on the sexual adverse effects of pharmacological, instrumental and surgical treatments of lower urinary tract symptoms related to benign prostatic hyperplasia (LUTS/BPH).

METHOD

A non-systematic review of the scientific literature was conducted from the PubMed database to retrieve the most relevant scientific publications. A first research was cross-referenced with the results of literature reviews already published and enriched by the authors of this review.

RESULTS AND CONCLUSION

Sexual dysfunction and SBAU/BPH are intimately linked by a cross-over effect in the population of men over 50, a possible common pathophysiology and treatments for BPH with sexual consequences. Evaluating the sexuality of patients in care for SBAU/BPH is therefore essential. Patients should be informed of potential adverse drug effects of BPH, including ejaculation disorders with alpha blockers and loss of libido and erectile dysfunction with 5 alpha reductase inhibitors. After BPH surgery, loss of antegrade ejaculation is common, although preservation possibilities exist. The improvement of urinary function and the decrease of possible ejaculatory pains have a beneficial effect on the sexuality of the BPH patients operated. More rarely, patients may experience orgasmic dysfunction or even erectile dysfunction with a possible thermal effect on the vasculo-nerve bundles.

LEVEL OF EVIDENCE

Consensus d'experts.

Erectile and ejaculatory functions changes following bipolar versus monopolar transurethral resection of the prostate: a prospective randomized study

OBJECTIVES

To compare monopolar and bipolar transurethral resection of the prostate (M-TURP and B-TURP, respectively) focusing on erectile and ejaculatory functions in a randomized trial.

METHODS

Between January 2013 and December 2014, all consecutive TURP candidates with benign prostatic hyperplasia (BPH) were prospectively randomized 1:1 into M-TURP/B-TURP arms and followed up at 2, and 4 weeks, 6 and 12 months after surgery. All patients were assessed using IIEF-15 (International index of erectile function-15) and Ej-MSHQ (ejaculatory domain-male sexual-health inventory). Changes in IIEF-15, its subdomains and Ej-MSHQ scores were compared between both intervention groups.

RESULTS

Following M.TURP and B.TURP; 122 and 124 patients were included respectively and were considered for analysis at 1 year. Sexual function did not differ significantly between arms during follow-up (erectile function, P = 0.82; orgasmic function, P = 0.46; sexual desire, P = 0.29; intercourse satisfaction, P = 0.18; overall satisfaction, P = 0.92). There were no differences between arms in the distribution of EF evolution at any time compared with base line (at 12 months: M-TURP vs. B-TURP = improved, 24.5 vs. 26.6%; stable, 66.4 vs. 64.5%; deteriorated, 9.1 vs. 8.9%; P = 0.41). Newly developed erectile dysfunction (ED) was present in 8.2 and 7.3% of patients following M.TURP and B.TURP respectively and was related to presence of DM and obesity. Orgasm perception significantly reduced following M.TURP and B.TURP (P < 0.001). Newly reported ejaculatory dysfunction (Ej-MSHQ < 22) was significantly associated with low orgasm perception.

CONCLUSIONS

There were no differences between M-TURP/B-TURP in any aspect of sexual function.

A Review of Male Sexual Health and Dysfunction Following Surgical Treatment for Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms

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.

Influence of Transurethral Resection of Bladder Cancer on Sexual Function, Anxiety, and Depression

The standard of care in non-muscle invasive bladder cancer consists of transurethral tumor resection. The aim of this study was to evaluate the influence of transurethral resection of bladder tumor (TURB) on the patients' self-reported depression, anxiety, sexual satisfaction, and erectile dysfunction. Psychological condition of 252 male patients who underwent TURB was prospectively evaluated. The Hospital Anxiety and Depression Scale (HADS), simplified International Index of Erectile Function (IIEF-5), and Sexual Satisfaction Questionnaires (SSQ) were administered to patients before and 10 days after tumor resection. We found that primary anxiety, depression, and erectile dysfunction were all worse in cancer patients than those in the general population, and all further worsened after tumor resection. The post-resection worsening was influenced by the operation and catheterization time, complications, and the tumor characteristics. Taxonomical analysis shows that the greatest risk of depression aggravation concerned patients who were younger, had a higher body mass index, and a medium-sized tumor. We conclude that transurethral resection of non-muscle invasive bladder cancer may adversely affect sexual function, anxiety, and depression. Patients should be informed about potential complications to prevent the abandonment of a follow-up. The findings of this study stress the role of personalized medicine pursued by a multidisciplinary medical team.

Current status of holmium laser enucleation of the prostate

There are several options for the surgical management of benign prostatic hyperplasia representatively from transurethral resection of the prostate. Holmium laser enucleation of the prostate is one of those options, and many institutions and urologists have initiated this technique, and most of them have accomplished better outcomes compared with transurethral resection of the prostate. In contrast to transurethral resection of the prostate, which requires a similar procedure to transurethral resection of bladder tumors, holmium laser enucleation of the prostate requires a special surgical technique: enucleation and morcellation with around 10 years' history of experience, even in Japan. The present review introduces the current status of holmium laser enucleation of the prostate, so that it surely contributes to the knowledge of International Journal of Urology readers who could be experienced surgeons or beginners as well.

Prospective controlled assessment of men's sexual function changes following Holmium laser enucleation of the prostate for treatment of benign prostate hyperplasia

OBJECTIVES

To assess how much Holmium laser enucleation of the prostate (HoLEP) is detrimental on men sexuality.

METHODS

Between January and December 2013, all patients presented for BPH surgery were assessed using IIEF-15 (international index of erectile function-15) and Ej-MSHQ (ejaculatory domain-male sexual health questionnaire). Changes in men's sexuality following HoLEP in relation to control procedure were prospectively assessed. Intervention group included legible consecutive patients treated by HoLEP. Control group included legible patients presented for diagnostic cystoscopy. Changes in IIEF-15, its subdomains and Ej-MSHQ scores were compared between HoLEP group and control.

RESULTS

At one year 80 and 70 subjects were included for final analysis following HoLEP and control groups, respectively. Regardless of the baseline erectile function (EF/IIEF) score, there was an increase in EF score similar to control following HoLEP (P = 0.6). However, among subjects with normal preoperative EF (score >25), in comparison with control, there was similar decline in EF score following HoLEP (P = 0.07). Regarding the orgasm domain, there was a significant reduction in orgasm perception following HoLEP in relation to control (P = 0.01). Patients reported desire changes, intercourse satisfaction and overall satisfaction scores similar to control following HoLEP. Using Ej-MSHQ score, there was no statistically significant difference between HoLEP and control groups in percentage of subjects reporting ejaculatory dysfunction at baseline. However, at 12 months, there was statistically significant more ejaculatory dysfunction reporting following HoLEP. The most common ejaculatory abnormality was volume abnormality. Orgasm perception was significantly decreased among subjects with newly reported ejaculatory dysfunction (5.3 ± 1.4 vs. 8.6 ± 1.3, P = 0.001).

CONCLUSIONS

Controlled short-term assessment of HoLEP showed potential negative impact on EF in patients with normal preoperative EF. Apart from orgasm perception, sexual function changes following HoLEP were similar to control. High prevalence of postoperative ejaculatory dysfunction following HoLEP remained notable finding.

Longitudinal changes in erectile function after thulium:YAG prostatectomy for the treatment of benign prostatic obstruction: a 1-year follow-up study

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.

Sexual Side Effects of Medical and Surgical Benign Prostatic Hyperplasia Treatments

Treatments for lower urinary tract symptoms due to benign prostatic hyperplasia can be evaluated by multiple metrics. A balance within the confines of patient expectations is key to determining the ideal treatment. A troubling adverse event for some patients is sexual dysfunction. Because the cohort of men who seek treatment of sexual dysfunction and lower urinary tract symptoms is essentially identical, these disease processes frequently overlap. This article considers potential pathophysiologic causes of dysfunction with treatment and attempts to critically review the available data to assess the true incidence of sexual adverse events with treatment.

Patient Perception of Ejaculatory Volume Reduction After Holmium Laser Enucleation of the Prostate (HoLEP)

OBJECTIVE

To investigate patient perception of ejaculatory volume reduction after Holmium laser enucleation of the prostate (HoLEP).

MATERIALS AND METHODS

A total of 192 patients were included in the analysis. All patients completed 6 self-developed, nonvalidated questionnaires. The questionnaires were composed of questions involving overall satisfaction, voiding symptom change, current experience of sexual intercourse, ejaculatory volume change, change of orgasmic intensity, and the patient's perception of postoperative ejaculatory volume reduction. Questionnaire results and clinical parameters were analyzed, and subgroup analysis according to the patient's perception was also performed.

RESULTS

The median patient age was 66.0 years, and the mean total prostate volume and enucleated prostate volume was 61.9 ± 24.1 mL and 22.4 ± 14.0 mL, respectively. Among 192 patients, 91 patients had had sexual intercourse within the past 3 months. Ejaculatory volume changes after HoLEP were as follows: "total loss" (76.9%), "decreased" (18.7%), and "no change"(4.4%). Among the 87 patients who reported ejaculatory volume reduction, their perceptions of this issue were as follows: "feels better"(2.3%), "not a problem" (16.1%), "disappointed, but able to tolerate, owing to improvement of voiding symptoms" (73.6%), and "dissatisfied and want to reverse the situation"(8.0%). Decreased orgasmic intensity was present in 48 (52.8%) patients. There were significantly more patients who reported decreased orgasmic intensity among those who wanted to reverse the situation compared with the others (P = .027).

CONCLUSION

Our study showed that most of the patients reported ejaculatory volume reduction and more than half of the patients reported decreased orgasmic intensity after HoLEP. We also found that patients' perceptions of ejaculatory volume reduction and orgasmic intensity were closely related to each other.

Comparison of Patients Undergoing PVP Versus TURP for LUTS/BPH

Transurethral resection of the prostate (TURP) and photoselective vaporization of the prostate (PVP) are currently the two most commonly performed procedures for the treatment of benign prostatic hyperplasia (BPH). While each procedure has been shown to be efficacious, TURP or PVP may be preferred in certain clinical scenarios. A number of factors may influence the choice of which patients undergo PVP or TURP. This decision may take into account patient characteristics, such as age, co-morbidities, predominance of irritative symptoms, and/or ongoing anticoagulation. Additionally, balancing desired outcomes with possible risks is critical. Considerations should include possible effects on sexual function, rates of reoperation, cost, and need for tissue specimen in those at risk for prostate cancer. The primary objective of this article is to summarize the comparative research of PVP and TURP and the implications on differences between patients who undergo either procedure.

Surgical Procedures for BPH/LUTS: Impact on Male Sexual Health

INTRODUCTION

Lower urinary tract symptoms (LUTS) because of benign prostatic hyperplasia (BPH) are a highly prevalent condition in men over 50 years old, and their incidence increases with age. The relationship between LUTS and erectile dysfunction (ED) has received increased attention recently because both diseases are highly prevalent, frequently co-associated in the same aging male group, and contribute significantly to the overall quality of life. In this review, we will examine the literature to assess the impact of surgical and minimally invasive treatments for LUTS/BPH on the male's sexual health.

METHODS

The impact of the various surgical and minimally invasive treatments for LUTS/BPH was reviewed to ascertain the impact on erectile and ejaculatory function.

RESULTS

Sexual side effects of treatment for LUTS/BPH are underappreciated by urologists but likely play a prominent role in patient decision making, creating a disparity between provider and patient. Almost all accepted therapies for LUTS (surgical or medical) can affect some aspect of sexual health, making it imperative that health-care professionals understand their patients' concerns and motivations in these two linked diseases. The incidence of newly diagnosed postoperative ED in patients treated with monopolar transurethral resection (TURP) is around 14%, with reported values in various studies ranging from 0-32.5%, 7.7%, 6.5%, 17%, to 14%. Importantly, there is no significant difference reported between bipolar and monopolar TURP on sexual function.

CONCLUSION

The risk of sexual side effects is an important one to consider in discussing the implications for any LUTS intervention as they play a prominent role in patient motivation, acceptance of bother and decision making concerning surgical intervention, thus creating a potential disparity between provider and patient. Becher EF and McVary KT. Surgical procedures for BPH/LUTS: Impact on male sexual health. Sex Med Rev 2014;2:47-55.

HoLEP does not affect the overall sexual function of BPH patients: a prospective study

We aimed to prospectively evaluate the influence of holmium laser enucleation of the prostate (HoLEP) on the overall postoperative sexual function of benign prostatic hyperplasia (BPH) patients with lower urinary tract symptoms (LUTS) and to explore the relationship between sexual function and LUTS. From January 2010 to December 2011, sixty sexually active consecutive patients with BPH who underwent HoLEP were prospectively enrolled in the study. All patients filled out the Male Sexual Health Questionnaire (MSHQ) for evaluation of their overall sexual function and the International Prostatic Symptom Score (IPSS) for pre- and post-operative 6 months evaluation of their voiding symptoms. The LUTS and sexual function changes were statistically analyzed. The preoperative and 6 months postoperative status of the patients was compared using uroflowmetry and IPSS questionnaires. The analysis revealed significant improvements following HoLEP. Among the sub-domains of the MSHQ, postoperative sexual function, including erection, ejaculation, sexual satisfaction, anxiety or sexual desire, did not significantly change after HoLEP (P > 0.05), whereas satisfaction scores decreased slightly due to retrograde ejaculation in 38 patients (63.3%). Sexual satisfaction improved significantly and was correlated with the improvements of all LUTS and the quality-of-life (QoL) domains in IPSS after surgery (QoL; relative risk [RR]: −0.293; total symptoms, RR: −0.411; P < 0.05). The nocturia score was associated with the erectile function score (odds ratio 0.318, P = 0.029). The change in ejaculatory scores did not show significant association with IPSS scores. HoLEP did not influence overall sexual function, including erectile function. In addition, sexual satisfaction improved in proportion with the improvement of LUTS.

Risk factors of sexual dysfunction after transurethral resection of the prostate (TURP): a 12 months follow-up

The aim of this study was to evaluate the impact of risk factors of erectile dysfunction (ED) after transurethral resection of the prostate (TURP) in men with lower urinary tract symptoms caused by bladder outlet obstruction secondary to benign prostatic hyperplasia. The study was conducted prospectively on 178 consecutive patients (normal IIEF-5 before surgery, ≥ 22) who underwent TURP. Patients were assessed before surgery and at 12 months. At 12 months, the IIEF-5 score significantly decreased from24 to 18 (p<0.0001). No statistical associations were found between hypertension, diabetes, dyslipidemia and capsular perforation and the development of ED after TURP. Operating time, duration of catheterization, and BMI did not determine a significant decrease of the IIEF-5 score after TURP. On univariable and multivariable linear regression analysis, age was the only risk factor associated with newly-reported ED 12 months after TURP (p<0.0001). On univariable andmultivariable logistic regression analysis, patients older than 65 yr had an higher risk of developing ED after TURP (p<0.0001) and they developed a lower IIEF-5 score (p<0.0001) at followup when compared with those ≤ 65 yr. These results suggest that age of patients represents an independent risk factor of ED at 12 months follow-up after TURP.

A systematic review of the correlates and management of nonpremature ejaculatory dysfunction in heterosexual men

INTRODUCTION

A better understanding of ejaculatory disorders has led to an increasing interest in nonpremature ejaculatory dysfunction (non-PE EjD). Current reviews on the subject use a symptom-based classification to describe ejaculatory dysfunction even when it is a single case report. While these reviews provide important information on the disorder, a clearer picture of the prevalence of non-PE EjD in relation to the community and various pathophysiologic states is needed.

OBJECTIVES

The objective of this study was to provide a systematic review of studies of non-PE EjD excluding single case reports.

METHODS

A systematic review of Medline for terms including ejaculation, orgasm or hematospermia. Association with terms delay, pain or headache was made. The search was restricted to male gender and articles written in English. Abstracts were reviewed and those mainly concerned with premature ejaculation were excluded.

RESULTS

A total of 333 articles on non-PE EjD were identified. The condition was reported in community-based studies. In certain patient populations, non-PE EjD was commonly reported in association with antidepressant and antipsychotic treatments, in patients with chronic prostatitis/chronic pelvic pain syndrome, patients with lower urinary tract symptoms particularly in association with medical or surgical treatment, patients with retroperitoneal surgery and in patients with neurological diseases. Few articles were concerned with treatment options.

CONCLUSION

There is a significant prevalence of non-PE EjD in the community and in association with particular disease states or as a side effect of medical or surgical interventions. There is a need to direct efforts to prevent and treat these conditions.

Update on the sexual impact of treatment for benign prostatic hyperplasia

There is an established link between lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) and erectile dysfunction (ED). The medical and surgical management of LUTS can affect erectile function (EF), cause ejaculatory dysfunction (EjD) or affect libido. This article will review the effects of these therapies on sexual function.

Improvement of erectile function in patients with benign prostatic hyperplasia undergoing transurethral plasmakinetic resection of the prostate

OBJECTIVE

Although transurethral resection of the prostate remains the gold standard surgical treatment for benign prostatic hyperplasia, transurethral plasmakinetic resection of the prostate has become a popular alternative. This study investigated the effects of plasmakinetic resection of the prostate on erectile function.

METHODS

A total of 400 patients that underwent plasmakinetic resection of the prostate or transurethral resection of the prostate were prospectively enrolled in this study. Of these, 384 patients met the inclusion criteria. One experienced surgeon carried out all the procedures. The International Prostate Symptom Score, International Index of Erectile Function-5, maximum flow rate and ultrasound postvoid residual volume were determined, and evaluated preoperatively and at 12 months postoperatively. Prostate-specific antigen, age and prostate volume of each patient were recorded.

RESULTS

The median International Index of Erectile Function-5 score of plasmakinetic resection of the prostate patients significantly increased from 8.0 (interquartile range 7.0-9.0) preoperatively to 21.0 (19.0-22.0) at 12 months postoperatively (P < 0.05). The score of plasmakinetic resection of the prostate patients was significantly higher than that of the transurethral resection of the prostate group (P < 0.05); however, the International Prostate Symptom Score of the plasmakinetic resection of the prostate group was not significantly different from that of the transurethral resection of the prostate group (P > 0.05).

CONCLUSIONS

A significant improvement in erectile function can be observed at 12 months in patients undergoing plasmakinetic resection of the prostate. Despite these encouraging findings, the effects of plasma kinetic resection of the prostate on erectile function remain to be further studied.

Evaluation of the Effect of Photoselective Vaporization of the Prostate on Sexual Function in a Prospective Study: A Single Center Experience of 150 Patients

Abstract Background and Purpose: Photoselective vaporization of the prostate (PVP) has emerged as a minimally invasive alternative to transurethral resection of the prostate for treatment of benign prostate hyperplasia (BPH) with lower urinary tract symptoms (LUTS). Very few prospective studies have addressed the effect of PVP on sexual function. We performed this prospective study to assess the short-term effect of PVP on erectile function in patients who present with LUTS secondary to BPH. Patients and Methods: There were 150 consecutive patients who presented with LUTS secondary to BPH who underwent PVP and who were enrolled prospectively in this study. Patients were categorized in two groups: Group A, International Index of Erectile Function (IIEF) ≥19; group B, IIEF <19. PVP was performed by using an 80 W GreenLight laser. Patients preoperative, perioperative, and follow-up data were recorded. Erectile function was assessed preoperatively and postoperatively at 1, 3, 6, and 12 months using IIEF-5. In follow-up, Ultrasonography of the kidneys, ureters, and bladder for residual prostate and postvoid residual urine, uroflowmetry, kidney function tests, and urine culture were performed at each visit. Cystoscopy was performed at 3 months. Data were analyzed statistically. Results: The two patient groups were comparable in their preoperative and perioperative data. Both groups showed improvement in International Prostate Symptom Score, maximum flow rate, quality of life, and decrease in postvoid residual urine at 1, 3, 6, and 12 months with no statistical significance. IIEF-5 scores in Group A, however, were 21.1, 19.2, 17.1, 16.2, and 16.1, respectively, at preoperative, postoperative month 1, 3, 6, and 12, respectively (P=0.02). IIEF-5 scores in Group B were 13.2, 12.1, 11.3, 11.2, and 10.9, respectively, at preoperative, postoperative month 1, 3, 6, and 12, respectively (P=0.45). Conclusions: In patients with normal preoperative erectile function, PVP resulted in significant decrease in EF up to follow-up of 1 year. In patients with preoperative ED, however, PVP did not significantly decrease EF.

Change in intraoperative rectal temperature influencing erectile dysfunction following transurethral resection of the prostate

BACKGROUND/PURPOSE

In this study, we assessed the relationship between changes in intraoperative rectal temperature and erectile function in patients who have undergone transurethral resection of the prostate.

METHODS

Eighty-six potential patients with benign prostatic hyperplasia-induced lower urinary tract symptoms were studied. Patients were divided into two groups: group 1-small prostates (<40 ml) and group 2-large prostates (≥ 40 ml), as determined by transrectal ultrasound measurement. The intraoperative rectal temperature was evaluated using a transrectal thermosensor and the differences between the highest intra- and preoperative temperatures were recorded. The erectile function at baseline, at three months and at one-year postoperatively was assessed using the International Index of Erectile Function-5 (IIEF-5) questionnaire.

RESULTS

Intraoperative rectal temperature differences were 0.54 ± 0.24°C for group 1 (n=45) and 0.44 ± 0.20°C for group 2 (n=41), (p=0.04). The IIEF-5 scores for group1 and group 2 were, respectively, 20.9 ± 1.6 and 20.6 ± 1.6 at baseline (p=0.32), 17.3 ± 2.9 and 18.7 ± 3.2 (p=0.037) at 3 months, 17.9 ± 2.7 and 18.7 ± 3.0 (p=0.17) at 1 year postoperatively. The deterioration of erectile function at 3 months post-operatively was observed for both groups. The percentage of retrograde ejaculation between two groups was not significantly different (p=0.33) at 1 year postoperatively.

CONCLUSION

Our study revealed that a higher intraoperative rectal temperature difference caused by transurethral resection of the prostate might affect the postoperative erectile function, particularly in patients with a small prostate.

The relationship between photoselective vaporization of the prostate and sexual function

Although transurethral resection of the prostate remains the gold standard treatment of lower urinary tract symptoms that are refractory to medical therapy, photovaporization of the prostate (PVP) has become a popular alternative. Early PVP studies have been encouraging, but insufficient data exist regarding the effects of PVP on long-term sexual function. This article analyzes the published data and briefly reviews the literature. The studies on PVP are heterogeneous, and other than one that showed a decreased International Index of Erectile Function score after PVP, all the studies analyzed the population at large and did not focus on preoperatively potent patients. Further well-conducted and prospective studies are needed to confirm the impact of PVP on erectile function.

La dysfonction érectile associée à une hypertrophie bénigne de prostate (HBP) symptomatique: son lien avec le stade évolutif de l’HBP, et son évolution sous différentes thérapeutiques

Introduction

Il existe une association entre les troubles mictionnels de l’hypertrophie bénigne de la prostate (HBP) et la dysfonction érectile (DE) dont la physiopathologie n’est pas complètement élucidée. De nombreuses publications ont mis l’accent sur le rôle de la sévérité des symptômes urinaires dans cette association et sur les résultats des différentes thérapeutiques utilisées. Aucune publication n’a jamais évoqué l’effet du stade évolutif des symptômes urinaires avec apparition de complications sur la DE.

Objectifs

Évaluer la corrélation entre la DE et le stade évolutif des troubles urinaires chez des patients présentant une HBP, et étudier l’évolution de cette DE sous différentes thérapeutiques.

Matériel et méthodes

Il s’agit d’une étude prospective menée sur une période de 12 mois, au CHU de Fès au Maroc, pendant laquelle ont été vus en consultation d’urologie 100 patients souffrant de troubles urinaires du bas appareil (TUBA) secondaires à une HBP. Leur fonction érectile avait été évaluée à l’aide du questionnaire IIEF-5 (Index international de la fonction érectile). Dans notre population, il n’était pas possible d’utiliser de façon fiable l’IPSS (International Prostatic Symptoms Score) ni d’avoir une idée exacte sur le début de la symptomatologie mictionnelle. Ainsi, nous avions étudié chez nos patients l’âge, le stade évolutif de l’HBP (HBP compliquée ou non) et la réponse de la DE aux différents traitements utilisés.

Résultats

L’âge moyen de nos patients était de 64,3 ans. Quarante patients (40 %) avaient une HBP compliquée et 60 patients une HBP non compliquée. La fonction érectile était fortement altérée chez 30 patients (75 %) ayant une HBP compliquée et chez 20 patients (33 %) ayant une HBP symptomatique non compliquée nécessitant un traitement médical. Le traitement médical par un alphabloquant (tamsulosine) avait contribué à améliorer la fonction érectile chez 12 patients de ce groupe (20 %). Les patients ayant une HBP compliquée avaient bénéficié d’un traitement chirurgical (résection transurétrale de prostate, RTUP, ou chirurgie ouverte), et la fonction érectile n’a pas été statistiquement améliorée dans ce groupe de patients.

Conclusion

Le risque de DE chez les patients présentant une HBP est lié au stade évolutif de l’HBP. En effet, ce risque est beaucoup plus important chez les patients ayant une HBP compliquée. Le traitement médical par un alphabloquant améliore la fonction érectile. Par contre, statistiquement parlant, la chirurgie n’améliore pas celle-ci.

Sexual impact of treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia

Lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) and the treatment of these conditions are commonly associated with sexual dysfunction. The effects on sexual function of common medical and surgical therapies used in the treatment of LUTS/BPH are reviewed. Also discussed is the emerging use of phosphodiesterase inhibitors in the treatment of LUTS/BPH.