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Lopategui DM, Shah HN, Herrmann TRW. Antegrade ejaculation preservation in surgical treatment for benign prostatic hyperplasia: quest for balance between voiding and sexual function. Curr Opin Urol 2024; 34:286-293. [PMID: 38595170 DOI: 10.1097/mou.0000000000001178] [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: 04/11/2024]
Abstract
PURPOSE OF REVIEW Surgical treatment of benign prostatic hyperplasia (BPH) carries a significant risk of ejaculation dysfunction. Preservation of antegrade ejaculation while providing effective, well tolerated, and durable treatment of BPH is a paramount component of physical and sexual well being for significant number of men. We reviewed available literature with an aim of providing status on antegrade ejaculation preserving BPH surgical therapies. RECENT FINDINGS Minimally invasive surgical therapies for BPH have been developed over the last decade, with significant marketing emphasis on their potential for preservation of antegrade ejaculation. However, the question about durability of relief of bladder outlet obstruction remains. Parallel to this technological development, the understanding of anatomical structures involved in ejaculation have resulted in technical modifications of well established surgical treatments modalities like transurethral resection of prostate, endoscopic enucleation of prostate and simple prostatectomy, thereby providing safe and durable relief of bladder outlet obstruction secondary to BPH with a satisfactory preservation of antegrade ejaculation. SUMMARY Preservation of antegrade ejaculation is an important goal for significant number of men needing BPH surgery. Novel minimally invasive surgical technologies have been developed for this purpose; but understanding of the anatomical structures essential for antegrade ejaculation have allowed technical modification of existing surgical techniques with excellent preservation of antegrade ejaculation.
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Affiliation(s)
- Diana M Lopategui
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Hemendra N Shah
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Thomas R W Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland
- Division of Urology, Department of Surgical Sciences, Stellenbosch University, Stellenbosch, South Africa
- Hannover Medical School, Hannover, Germany
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Kaltsas A, Kratiras Z, Zachariou A, Dimitriadis F, Sofikitis N, Chrisofos M. Evaluating the Impact of Benign Prostatic Hyperplasia Surgical Treatments on Sexual Health. Biomedicines 2024; 12:110. [PMID: 38255215 PMCID: PMC10813562 DOI: 10.3390/biomedicines12010110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Benign prostatic hyperplasia (BPH), a prevalent condition in older men, is often managed through various surgical interventions. This narrative review aims to explore the impact of these surgical treatments on sexual function, a critical aspect of patient quality of life often overlooked in BPH management. The methodology encompassed a thorough review of contemporary surgical techniques for BPH, including prostate resection, enucleation, vaporization, and minimally invasive therapies such as UroLift, Rezum, and Aquablation. Additionally, the focus was on patient-centered outcomes, with a special emphasis on sexual health following surgery. Findings reveal that, while surgical interventions effectively alleviate BPH symptoms, they often have significant repercussions in sexual function, including erectile and ejaculatory dysfunction. However, emerging techniques demonstrate potential in preserving sexual function, underscoring the need for patient-centric treatment approaches. The study highlights the complex interplay between BPH surgery and sexual health, with minimally invasive treatments showing promise in balancing symptom relief and sexual function preservation. In conclusion, the study advocates for an integrated, interdisciplinary approach to BPH treatment, emphasizing the importance of considering sexual health in therapeutic decision-making. This narrative review suggests a paradigm shift towards minimally invasive techniques could optimize patient outcomes, marrying symptom relief with quality-of-life considerations. The need for further research in this domain is evident, particularly in understanding long-term sexual health outcomes following different surgical interventions for BPH.
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Affiliation(s)
- Aris Kaltsas
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (Z.K.)
| | - Zisis Kratiras
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (Z.K.)
| | - Athanasios Zachariou
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.Z.); (N.S.)
| | - Fotios Dimitriadis
- Department of Urology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Nikolaos Sofikitis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.Z.); (N.S.)
| | - Michael Chrisofos
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (Z.K.)
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Migliari R, Mele F, Barale M, De Rosa G, Migliari M, Giacobbe A. An Innovative Technique for Ejaculation-Sparing Prostatic Enucleation with Thulium:YAG Laser. J Endourol 2023; 37:1282-1288. [PMID: 37742104 DOI: 10.1089/end.2023.0093] [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] [Indexed: 09/25/2023] Open
Abstract
Purpose: We report our experience with 100 patients who underwent an innovative prostate enucleation technique that spares the complete urethral-plate from the veru montanum to the bladder neck using a low-energy thulium laser emission. The aim of our study was to evaluate the short-term effects of this procedure on ejaculation preservation and urinary obstruction. Materials and Methods: The International Prostate Symptom Index (IPSS), quality of life (QoL), and Male Sexual Health Questionnaire Ejaculatory Dysfunction (MSHQ-EJD) Short Form were used as validated instruments to quantify ejaculatory dysfunction before and 6 months after the surgery. Results: The median IPSS score pre- and postoperatively was 20 and 5, respectively (p < 0.0001); QoL dropped from a median of 4-1 (p < 0.0001); and the mean preoperative maximal flow rate improved significantly (8.5 vs 21.2 mL/min) (p < 0.0001). Furthermore, there was significant reduction in postvoid residual postoperatively (p < 0.0001). Postoperative ejaculatory function was preserved in 92/100 patients (92%). According to the MSHQ-EJD score, patients reported a slight nonsignificant decrease in frequency of ejaculation (item 1), force of expulsion (item 2) and reduction in semen volume during ejaculation (item 3), with the exception of ejaculation discomfort (item 4). Conclusion: According to our results, complete removal of the apical tissue, which has been advocated as an integral part of the so called ejaculatory hood, does not interfere with ejaculation if the ventral lissosphincter remains intact.
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Affiliation(s)
| | - Fabrizio Mele
- Department of Urology, Mauriziano Hospital, Turin, Italy
| | | | | | - Marco Migliari
- Department of Medical Oncology, University Hospital of Cagliari, Cagliari, Italy
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Guldibi F, Altunhan A, Aydın A, Sonmez MG, Çakır ÖO, Balasar M, Guven S, Ahmed K. What is the effect of laser anatomical endoscopic enucleation of the prostate on the ejaculatory functions? A systematic review. World J Urol 2023; 41:3493-3501. [PMID: 37921935 DOI: 10.1007/s00345-023-04660-0] [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: 06/05/2023] [Accepted: 09/21/2023] [Indexed: 11/05/2023] Open
Abstract
INTRODUCTION Laser anatomical endoscopic enucleation of the prostate (LAEEP) has emerged as a promising new approach in endoscopic surgery for BPH. LAEEP could still result in ejaculatory dysfunction. AIM This systematic review aimed to examine the impact of LAEEP on male ejaculatory functions. METHODS The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, and 15 records were included. Outcomes of interest included ejaculatory dysfunction (retrograde ejaculation, painful ejaculation, etc.) and validated questionnaire scores. The quality of studies included in the systematic review was determined using QUADAS scoring. RESULTS We retrieved data for 1877 men in 15 clinical studies investigating LAEEP surgery and reporting EjD rates. While only three of the obtained studies were on thulium fiber (ThuLEP), the rest were on holmium (HoLEP). The definition of "Ejaculatory Dysfunction" was not standardized, but in most works, it is referred to as retrograde ejaculation (RE). There were no data on the relationship between other LAEEP techniques and ejaculation functions. The authors compared the outcomes of used standard laser enucleation techniques with the modified techniques. The RE rate in LAEEP was 62.1 ± 25.1%, 71.3 ± 16.1% in standard techniques, and 27.2 ± 18.1% in ejaculation-preserving modified techniques (p < 0.001). CONCLUSION This review demonstrated that ejaculation-preserving techniques, i.e., modified techniques are superior to standard techniques. Studies have also shown that ejaculatory dysfunction rates gradually decrease with long-term follow-ups. Future well-designed studies could further investigate the ejaculation-preserving modification of LAEEP techniques and how they impact EjD rates and other sexual function outcomes.
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Affiliation(s)
- Furkan Guldibi
- Meram School of Medicine, Urology Department, Necmettin Erbakan University, Konya, Turkey
| | - Abdullah Altunhan
- Meram School of Medicine, Urology Department, Necmettin Erbakan University, Konya, Turkey
| | | | - Mehmet Giray Sonmez
- Meram School of Medicine, Urology Department, Necmettin Erbakan University, Konya, Turkey
| | - Ömer Onur Çakır
- Department of Urology, King's College Hospitals, London, UK
- MRC Centre for Transplantation, King's College London, Guy's Hospital Campus, London, UK
| | - Mehmet Balasar
- Meram School of Medicine, Urology Department, Necmettin Erbakan University, Konya, Turkey
| | - Selcuk Guven
- Meram School of Medicine, Urology Department, Necmettin Erbakan University, Konya, Turkey.
| | - Kamran Ahmed
- Meram School of Medicine, Urology Department, Necmettin Erbakan University, Konya, Turkey
- Sheikh Khalifa Medical City, Abu Dhabi, UAE
- Khalifa University, Abu Dhabi, UAE
- Department of Urology, King's College Hospitals, London, UK
- MRC Centre for Transplantation, King's College London, Guy's Hospital Campus, London, UK
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Lebdai S, Ben Boujema M, Benard A, Barry Delongchamps N, Benchikh A, Bruyere F, Della Negra E, Descazeaud A, Doizi S, Fourmarier M, Mallet R, Misrai V, Pelegrin T, Rouscoff Y, Ruffion A, Villers A, Saillour F, Robert G. Standardized technique for ejaculation preservation during prostatic endoscopic ablative surgery. World J Urol 2023; 41:3041-3049. [PMID: 37715788 DOI: 10.1007/s00345-023-04592-9] [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: 05/06/2023] [Accepted: 08/15/2023] [Indexed: 09/18/2023] Open
Abstract
PURPOSE Ejaculatory dysfunction is the most common side effect of benign prostatic hyperplasia surgery. Modified techniques have emerged with the aim of preserving antegrade ejaculation without compromising obstruction relief. None are standardized or validated. The PARTURP study is a randomized study investigating partial versus complete prostate resection. We conducted an investigator consensus meeting to define the ideal surgical technique to achieve both correct obstruction relief with ejaculation preservation. METHODS An expert consensus meeting involving all investigators of the PARTURP study took place to define a common technique using the nominal group methodology. The objectives were to define the areas to be resected and the areas to be preserved; to define the criteria for proper obstruction relief; to define the criteria for proper ejaculation preservation. RESULTS All investigators (n = 15) attended the consensus meeting, and agreement between all the participants was obtained. The anatomical landmarks to be preserved are located around the verumontanum and along the posterior part of the prostatic urethra. These structures must be preserved up to 2 cm from the verumontanum. The participants agreed on the need to preserve the urethral mucosa in all the areas to be preserved and to reach the enucleation plane in the areas of resection. CONCLUSIONS Anatomical landmarks for ejaculation-sparing surgery have been defined by the investigators of the PARTURP randomized study. These landmarks will be used during the study, and the clinical outcomes of this ejaculation-sparing technique will be compared with complete resection with up to 3 years follow-up.
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Affiliation(s)
- Souhil Lebdai
- Urology Department, University Hospital of Angers, CHU Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France.
| | - Méric Ben Boujema
- Methodology Department, University Hospital of Bordeaux, Bordeaux, France
| | - Antoine Benard
- Methodology Department, University Hospital of Bordeaux, Bordeaux, France
| | | | - Amine Benchikh
- Urology Department, Clinique Des Franciscaines, Versailles, France
| | - Franck Bruyere
- Urology Department, University Hospital of Tours, Tours, France
| | | | | | - Steeve Doizi
- Urology Department, Hôpital Tenon, APHP, Paris, France
| | | | - Richard Mallet
- Urology Department, Hôpital Prive Francheville, Périgueux, France
| | | | | | - Yohan Rouscoff
- Urology Department, Polyclinique Saint Georges, Nice, France
| | - Alain Ruffion
- Urology Department, University Hospital of Lyon, Lyon, France
- EA 3738-CICLY EMR UCBL Lyon 1, Lyon, France
| | - Arnaud Villers
- Urology Department, University Hospital of Lille, Lille, France
| | - Florence Saillour
- Methodology Department, University Hospital of Bordeaux, Bordeaux, France
| | - Grégoire Robert
- Urology Department, University Hospital of Bordeaux, Bordeaux, France
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Sibona M, Destefanis P, Vercelli E, Secco S, Gontero P, Cindolo L. Ejaculation physiology and dysfunction after BPH surgery: the role of the new MISTs. Prostate Cancer Prostatic Dis 2023; 26:475-482. [PMID: 37500787 DOI: 10.1038/s41391-023-00686-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/25/2023] [Accepted: 06/14/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Human ejaculation can be defined as a complex and still largely unknown function. Since decades, Benign Prostatic Hyperplasia (BPH) surgery-associated loss of antegrade ejaculation has been reported as a bother by many patients. New technologies and modified surgical techniques were developed, to reduce the impact of ejaculatory dysfunction on patients' perceived quality of life. Recently, the emerging of the new Minimally Invasive Surgical Techniques (MISTs) empowered the urological surgeons with the technological means to introduce the ejaculation-sparing principles into everyday clinical practice. METHODS Our paper was conceived as a state-of-the-art analysis about the anatomical and physiological premises of the human ejaculation and their clinical application in the field of ejaculation-sparing surgery for the treatment of Lower Urinary Tract Symptoms (LUTS). Moreover, we proposed an innovative physiological model for antegrade ejaculation. RESULTS We analysed the elements of the "ejaculatory apparatus" from an anatomical point of view. We investigated the physio-pathological models of the human ejaculation, from the classical "combustion chamber" paradigm to the new evidences by which it could be overcome. Finally, we provided a synthetic literature review about the ejaculation-sparing techniques for BPH surgery. Particularly, we distinguished them between classical techniques, modified for ejaculation-preserving purposes, and the new MISTs, characterized by the introduction of new technologies and different treatment modalities. CONCLUSIONS Modified surgical techniques and new technologies opened new perspectives about human ejaculation. Previously established functional paradigms were questioned and overcome by recent clinical evidence. The new MISTs gained a prominent role in the process, opening a whole new era for BPH surgery.
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Affiliation(s)
- Mattia Sibona
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy.
| | - Paolo Destefanis
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Eugenia Vercelli
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Silvia Secco
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paolo Gontero
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Luca Cindolo
- Department of Urology, Hesperia Hospital, CUrE Group, Modena, Italy
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7
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Gravas S, Gacci M, Gratzke C, Herrmann TRW, Karavitakis M, Kyriazis I, Malde S, Mamoulakis C, Rieken M, Sakalis VI, Schouten N, Speakman MJ, Tikkinen KAO, Cornu JN. Summary Paper on the 2023 European Association of Urology Guidelines on the Management of Non-neurogenic Male Lower Urinary Tract Symptoms. Eur Urol 2023; 84:207-222. [PMID: 37202311 DOI: 10.1016/j.eururo.2023.04.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/06/2023] [Indexed: 05/20/2023]
Abstract
CONTEXT Lower urinary tract symptoms (LUTS) are common, often bothersome, and have multifactorial aetiology. OBJECTIVE To present a summary of the 2023 version of the European Association of Urology guidelines on the management of male LUTS. EVIDENCE ACQUISITION A structured literature search from 1966 to 2021 selected the articles with the highest certainty evidence. The Delphi technique consensus approach was used to develop the recommendations. EVIDENCE SYNTHESIS The assessment of men with LUTS should be practical. A careful medical history and physical examination are essential. Validated symptom scores, urine test, uroflowmetry, and postvoid urine residual, as well as frequency-volume charts for patients with nocturia or predominately storage symptoms should be used. Prostate-specific antigen should be ordered if a diagnosis of prostate cancer changes the treatment plan. Urodynamics should be performed for selected patients. Men with mild symptoms are candidates for watchful waiting. Behavioural modification should be offered to men with LUTS prior to, or concurrent with, treatment. The choice of medical treatment depends on the assessment findings, predominant type of symptoms, ability of the treatment to change the findings, and the expectations to be met in terms of the speed of onset, efficacy, side effects, and disease progression. Surgery is reserved for men with absolute indications, and for patients who fail or prefer not to receive medical therapy. Surgical management has been divided into five sections: resection, enucleation, vaporisation, and alternative ablative and nonablative techniques. The choice of surgical technique depends on patient's characteristics, expectations, and preferences; surgeon's expertise; and availability of modalities. CONCLUSIONS The guidelines provide an evidence-based approach for the management of male LUTS. PATIENT SUMMARY A clinical assessment should identify the cause(s) of symptoms and define the clinical profile and patient's expectations. The treatment should aim to ameliorate symptoms and reduce the risk of complications.
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Affiliation(s)
- Stavros Gravas
- Department of Urology, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Christian Gratzke
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | | | - Markos Karavitakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Iason Kyriazis
- Department of Urology, General University Hospital of Patras, Patras, Greece
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | | | - Vasileios I Sakalis
- Department of Urology, Hippokrateion General Hospital, Thessaloniki, Greece.
| | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Mark J Speakman
- Department of Urology, Taunton & Somerset Hospital, Taunton, UK
| | - Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Surgery, South Karelia Central Hospital, Lappeenranta, Finland
| | - Jean-Nicolas Cornu
- Department of Urology, CHU Hôpitaux de Rouen - Hôpital Charles Nicolle, Rouen, France
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Press B, Gardezi M, Kim DD, Lokeshwar S, Rahman S, Siev M, Ghiraldi E, Lerner L, Kellner D. Ejaculatory Preserving Holmium Laser Enucleation of the Median Lobe: Preserving Sexual Function While Improving Urinary Outcomes. Urology 2023; 173:175-179. [PMID: 36646177 DOI: 10.1016/j.urology.2022.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 12/11/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To evaluate perioperative outcomes related to sexual and urinary function in patients who underwent a holmium laser enucleation of the prostate (HoLEP) with selective laser enucleation of the median lobe. MATERIALS AND METHODS We retrospectively reviewed the first 450 HoLEP cases by a single surgeon from April 2019 to March 2022. Fifty-five patients with intravesical-prostatic protrusion or high bladder neck without obstructing lateral lobes underwent selective enucleation of the median lobe of the prostate. Patients were asked to comment on whether they had retrograde ejaculation during their follow-up appointment. Urinary function was assessed using the American Urological Association Symptom Score and subjective evaluation of urinary incontinence. RESULTS Median age of the cohort was 65 years (range: 44-91). Compared to preoperative, there was significant improvement in mean postoperative American Urological Association Symptom Score (22.5 vs 6.9, P < .001), mean postoperative quality of life scores (4 vs 1.2, P < .001), and mean postoperative post void residual volumes (244.1 vs 69.3 cc, P < .001). No patients reported stress urinary incontinence. Of the 55 patients who underwent selective enucleation of the median lobe, 40 were sexually active. Of those men, 35 reported normal ejaculation, 3 had retrograde ejaculation that was unchanged from pre-op, and 2 had new ejaculatory dysfunction. CONCLUSION In this case series of selective laser enucleation of the median lobe, urinary function significantly improved in short-term follow-up with preservation of ejaculation in approximately 90% of men.
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Affiliation(s)
- Benjamin Press
- Department of Urology, Yale School of Medicine, Yale University, New Haven, CT
| | | | - David D Kim
- Yale School of Medicine, Yale University, New Haven, CT
| | - Soum Lokeshwar
- Department of Urology, Yale School of Medicine, Yale University, New Haven, CT
| | - Syed Rahman
- Department of Urology, Yale School of Medicine, Yale University, New Haven, CT
| | - Michael Siev
- Department of Urology, Yale School of Medicine, Yale University, New Haven, CT
| | - Eric Ghiraldi
- Division of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | - Lori Lerner
- Division of Urology, VA Boston Healthcare System, Boston, MA
| | - Daniel Kellner
- Department of Urology, Yale School of Medicine, Yale University, New Haven, CT.
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Goyal P, Salem R, Mouli SK. Controversies in Prostate Artery Embolization: Future Best Practice. Semin Intervent Radiol 2022; 39:562-570. [PMID: 36561793 PMCID: PMC9767779 DOI: 10.1055/s-0042-1759701] [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: 12/24/2022]
Abstract
Prevalence of lower urinary tract symptoms secondary to benign prostatic hyperplasia is correlated with age. Men seeking treatment options with a low side effect profile often turn to prostate artery embolization (PAE). PAE continues to be refined with advanced tools and optimized techniques. Nonetheless, there exist controversies in terms of best practices for the management of lower urinary track symptoms (LUTS) with PAE. These controversies are essential for medical progress. Herein we suggest best practices moving forward based on currently available data. Given extensive safety data, we recommend PAE be considered alongside medical management and as a precursor to surgery. Given demonstrated efficacy across gland sizes, PAE can be performed in a single session, ideally in a hybrid angio-CT suite, without preoperative cross-sectional imaging. PAE should be initially performed with 300- to 500-μm size particles, and instead consider exploring other particles and sizes for repeat PAE. Finally, PAE can also be considered as first-line option for recurrent disease given the efficacy and excellent safety profile. This article is not meant to purport a dogma, but rather to serve as a guide to the experienced practitioner in challenging his or her own biases when performing PAE.
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Affiliation(s)
- Piyush Goyal
- Section of Interventional Radiology, Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Riad Salem
- Section of Interventional Radiology, Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Samdeep K. Mouli
- Section of Interventional Radiology, Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
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10
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Ejaculation Sparing Thulium Laser Enucleation of the Prostate: An Observational Prospective Study. J Clin Med 2022; 11:jcm11216365. [PMID: 36362593 PMCID: PMC9658552 DOI: 10.3390/jcm11216365] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/22/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
Benign prostatic hypertrophy (BPH) is a condition that appears with advancing age and affects 1/3 of men over 50 years, resulting in filling and emptying symptoms. One of the main limitations of endoscopic techniques for BPH is the occurrence of retrograde ejaculation. The purpose of this prospective observational study is to evaluate the efficacy and feasibility of ejaculation-sparing thulium laser enucleation of the prostate (ES-ThuLEP) in the treatment of BPH-related LUTS and the preservation of ejaculation. Sexually active patients with BPH were enrolled and followed up with at 3, 6, and 12 months after surgery. Personal and pharmacological histories were collected, while three standardized questionnaires—the International Index of Erectile Function short form (IIEF-5), the International Consultation on Incontinence Questionnaire for Male Sexual Matters Associated with Lower Urinary Tract Symptoms Module (ICIQ—MLUTSsex), and the International Prostatic Symptom Score (IPSS)—were administered. In addition, all patients underwent uroflowmetry and an assessment of post-void residual volume (PVR). A total of 53 patients were enrolled. A statistically significant improvement in the IPSS score, maximum flow (Qmax), and post-void volume (PVR) at 3 months, 6 months, and 12 months after surgery was found (p < 0.05), while no statistically significant differences were reported between IIEF-5 scores before and after surgery. A total of 48 patients (88.6%) had preserved ejaculation at 3 months, while 92.4% and 94.3% of patients reported preserved ejaculation at 6 and 12 months, respectively. Nevertheless, some degree of hypoposia was referred, at 3, 6, and 12 months, by 43.7%, 30.6%, and 13.2% of patients, respectively. The ES-ThuLEP technique successfully preserved ejaculation in over 90% of patients, representing an ejaculation-sparing alternative in the treatment of BPH.
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11
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Rouf MA, Kumar V, Agarwal A, Rawat S. Ejaculation preserving HoLEP/TURP for benign prostatic hyperplasia: myth or reality. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158211000196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: To analyze whether technical modifications during transurethral resection of the prostate/holmium laser enucleation of the prostate results in preservation of antegrade ejaculation, at the same time providing effective relief from bladder outlet obstruction. Materials and methods: A total of 119 patients with benign prostatic hyperplasia were included in the study carried out at our center between March 2016 and December 2018. The patients were divided into two groups, with 56 (47.06%) patients in the ejaculation-preserving transurethral resection of the prostate group and 63 (52.94%) patients in the ejaculation-preserving holmium laser enucleation of the prostate group. The patients in the two groups were assessed with respect to age, prostate size, serum prostate-specific antigen and any comorbidity. The parameters assessed pre and postoperatively include Qmax, international prostate symptom score, peripheral vascular resistance, overall sexual satisfaction and overall ejaculation. All patients were regularly followed up during the study period and were included in the final analysis. Results: The mean (standard deviation) age, prostate size, serum prostate-specific antigen of patients who underwent ejaculation-preserving transurethral resection of the prostate and patients who underwent ejaculation-preserving holmium laser enucleation of the prostate was 61.67 (5.26)/61.48 (5.40) years, 59.75 (10.61) ml/74.44 (20.27) ml, 2.38 (0.77) ng/ml/2.47 (0.83) ng/ml, respectively. Postoperatively there was a statistically significant improvement in Qmax, international prostate symptom score and peripheral vascular resistance in both groups. The overall sexual satisfaction after surgery improved significantly in the ejaculation-preserving transurethral resection of the prostate group; however, it deteriorated significantly in the ejaculation-preserving holmium laser enucleation of the prostate group, which was statistically significant at 6 months. After treatment, the overall ejaculation assessed by asking question 9 of the international index of erectile function 15 questionnaire was unchanged in patients from the ejaculation-preserving transurethral resection of the prostate group and deteriorated in the ejaculation-preserving holmium laser enucleation of the prostate group and the difference between the two groups was statistically significant. Conclusion: An ejaculation preserving technique seems to be more feasible in small prostate glands when appreciable apical tissue is spared. However, holmium laser enucleation of the prostate is basically a size-independent procedure and enables the complete removal of the adenoma tissue like an open prostatectomy. To compromise the extent of tissue removal or candidate selection for a better ejaculation preservation outcome might damage the indigenous value of the holmium laser enucleation of the prostate. To conclude, if the preservation of sexual satisfaction and ejaculatory function is a priority, patients should be offered ejaculation-preserving transurethral resection of the prostate as the treatment of choice over ejaculation-preserving holmium laser enucleation of the prostate.
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Affiliation(s)
- Malik Abdul Rouf
- Department of Urology, Inraprastha Apollo Hospital, New Delhi, India
| | - Venkatesh Kumar
- Department of Urology, Inraprastha Apollo Hospital, New Delhi, India
| | - Anshuman Agarwal
- Department of Urology, Inraprastha Apollo Hospital, New Delhi, India
| | - Suresh Rawat
- Department of Urology, Inraprastha Apollo Hospital, New Delhi, India
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12
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Ejaculations and Benign Prostatic Hyperplasia: An Impossible Compromise? A Comprehensive Review. J Clin Med 2021; 10:jcm10245788. [PMID: 34945084 PMCID: PMC8704358 DOI: 10.3390/jcm10245788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/03/2021] [Accepted: 12/08/2021] [Indexed: 01/23/2023] Open
Abstract
Background: Benign prostatic hyperplasia (BPH) is commonly responsible for lower urinary tract symptoms (LUTS) in men aged 50 or over. Sexual dysfunctions, such as ejaculatory disorders (EjD), go along with LUTS but are frequently overlooked in the initial evaluation. This review aimed to detail BPH-related EjD, as well as their modifications by medical, surgical, and interventional treatments. Methods: We conducted a narrative review looking for publications between 1990 and 2020, regarding physiopathology, epidemiology, evaluation, and therapeutic management (medical, surgical, and interventional) of BPH-related EjD. Results: Sixty-five articles were included in our final analysis. Forty-six percent of men presenting with LUTS reported EjD. If the prevalence increases with age and LUTS severity, the functional impairment is not correlated with age. Several self-questionnaires evaluated the sexual function, but only four approaches are specific to EjD. Medical therapies were exposed to anejaculation, rather than retrograde ejaculation (RE) (4–30% (alpha-blockers), 4–18% (5-alpha-reductase inhibitors)). Regarding surgical therapies, trans-urethral resection of the prostate (TURP) and incision of the prostate (TUIP) are associated with 50–70% and 21–35% of RE. The RE rate is important after open simple prostatectomy but can be reduced with robotic approaches and urethral sparing techniques (19%). Anatomic endoscopic enucleation of the prostate (AEEP) with or without a laser source is associated with an 11–36% RE rate, according to supramontanal preservation. Recent surgical techniques (Rezum©, Aquablation©, or Urolift©) were developed to preserve antegrade ejaculation with promising short-term results. Regardless of the surgical approach, anatomic studies suggest that the preservation of peri-montanal tissue (7.5 mm laterally; 10 mm proximally) is primordial to avoid post-operative RE. Finally, prostate artery embolization (PAE) limits the RE rate but exposes it to a 12 months 10% re-intervention rate. Conclusion: EjD concerns almost half of the patients presenting BPH-related LUTS. Initial evaluation of EjD impairment is primordial before medical or surgical therapy. Peri-montanal tissue preservation represents a key point for antegrade ejaculation preservation, regardless of the surgical option.
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13
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You C, Li X, Du Y, Wang H, Wei T, Zhang X, Wang A. Comparison of different laser-based enucleation techniques for benign prostate hyperplasia: A systematic review and meta-analysis. Int J Surg 2021; 94:106135. [PMID: 34600125 DOI: 10.1016/j.ijsu.2021.106135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/17/2021] [Accepted: 09/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND To summarize the current evidence on different laser-based enucleation techniques for benign prostate hyperplasia and compare the efficacy and safety of en-bloc, two-lobe and three-lobe techniques. MATERIALS AND METHODS Through a systematical search of multiple scientific databases in March 2021, we performed a systematic review and cumulative meta-analysis of the primary outcomes of interest according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) Guidelines, whose protocol was registered with PROSPERO(CRD42021240684). RESULTS A total of 9 studies were included. All three laser enucleation techniques had no statistically significant difference in terms of enucleated prostate weight, maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR), international prostate symptom score (IPSS), transient UI (TUI), persistent UI (PUI) and early postoperative complications. A shorter enucleation time was associated with the en-bloc technique compared to three technique (MD: -8.26, 95%CI: -12.73--3.79, p = 0.0003), whereas no significant difference was found in en-bloc versus two-lobe technique (MD:0.97,95%CI: -0.30-2.24,p = 0.13) and two-lobe versus three-lobe technique (MD: -3.19, 95%CI: -7.45-1.06, p = 0.14). A higher enucleation rate was associated with the en-bloc and two-lobe technique (MD: 0.05, 95%CI: 0.00-0.10, p = 0.03; MD: 0.09, 95%CI: 0.01-0.17, p = 0.03, respectively). A superior QoL was related to the two-lobe enucleation technique compared to three-lobe technique (MD: 0.22, 95%CI: 0.06-0.39, p = 0.009), whereas no meaningful difference was found in the group of en-bloc versus two-lobe (MD: -0.12, 95%CI: -0.62-0.37, p = 0.62) and group of en-bloc versus three-lobe (MD: -0.14, 95%CI: -0.56-0.29, p = 0.52). CONCLUSIONS En-bloc and two-lobe laser-based enucleation techniques are feasible and safe alternative to three-lobe technique with comparable surgical outcomes and similar functional outcomes. A superior enucleation efficiency was associated with En-bloc and the two-lobe techniques compared to the three-lobe technique.
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Affiliation(s)
- Chengyu You
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College, Nanchong, 63700, Sichuan, China
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14
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The role of benign prostatic hyperplasia treatments in ejaculatory dysfunction. Fertil Steril 2021; 116:611-617. [PMID: 34462095 DOI: 10.1016/j.fertnstert.2021.07.1199] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 11/23/2022]
Abstract
Ejaculatory dysfunction is not only psychologically distressing but can become a significant obstacle for men who wish to conceive. Dysfunction comes in the form of anejaculation, reduced ejaculation, retrograde ejaculation, painful ejaculation, or premature ejaculation. Most treatments for lower urinary tract symptoms related to benign prostatic hyperplasia, which commonly occurs in aging men, carry significant risks of absent, reduced, or retrograde ejaculation. This review focuses on such risks that accompany both the medical and surgical management of lower urinary tract symptoms/benign prostatic hyperplasia and how these risks impact male fertility.
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15
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Elshazly M, Sultan S, Shaban M, Zanaty F. Evaluation of a novel technique of bladder neck and supramontanal sparing ejaculatory preserving transurethral prostatectomy. World J Urol 2021; 39:4215-4219. [PMID: 34091741 DOI: 10.1007/s00345-021-03752-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] [Received: 02/04/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Transurethral resection of the prostate (TURP) can achieve highly satisfying symptomatic and functional outcomes but the loss of antegrade ejaculation represents a major reason for the avoidance of surgical treatment to preserve normal ejaculation and paternity. We present a novel technique to duplicate both bladder neck sparing and supramontanal sparing with resection of apical tissues to improve voiding and antegrade ejaculation. METHODS A prospective study done from June 2018 to June 2020 on 60 consecutive male patients with normal sexual activity diagnosed with benign prostatic enlargement. These patients were randomized into two groups; 30 patients in each group. Group 1 underwent bladder neck and supramontanal sparing ejaculatory preserving transurethral bipolar resection of prostate (ep-TUBRP) and Group 2 underwent classic transurethral bipolar resection of prostate (c-TUBRP). All patients were evaluated pre- and postoperatively (after 3 months) using IPSS, Qmax and by IIEF-5. RESULTS In both groups, there were significant improvements 3 months postoperative in Qmax [7.97 mL/s to 18.47 mL/s (group A) and 7.8 to 20.7 mL/s (group B)] and in micturition symptoms according to reductions in IPSS score [24 to 7.5 (group A) and 25 to 8.5 (group B)]. IIEF-5 score improved significantly from a mean of 12.9 to 18.6 (group A) and from 11.6 to 16.4 (group B). Antegrade ejaculation reported in 80% of patients in group A and 27% in group B which was significant (p < 0.001). Postoperative period did not reveal acute urinary retention, stress urinary incontinence, or serious adverse events. CONCLUSIONS On short-term results, bladder neck and supramontanal ejaculation preserving transurethral bipolar resection of the prostate is superior to classic TURP in preservation of forward ejaculation with comparable efficacy in micturition parameters.
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Affiliation(s)
- Mohamed Elshazly
- Department of Urology, Menoufia University Hospitals, Shebeen el kom, Egypt
| | - Sultan Sultan
- Department of Urology, Menoufia University Hospitals, Shebeen el kom, Egypt
| | - Mohamed Shaban
- Department of Urology, Nasser Institute for Research and Treatment, Cairo, Egypt
| | - Fouad Zanaty
- Department of Urology, Menoufia University Hospitals, Shebeen el kom, Egypt.
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16
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Cardoso A, Lima E. Urethra-sparing minimally invasive simple prostatectomy: an old technique revisited. Curr Opin Urol 2021; 31:18-23. [PMID: 33229863 DOI: 10.1097/mou.0000000000000836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to review recent development in urethra and ejaculation preserving laparoscopic and robotic simple prostatectomy. RECENT FINDINGS Since Madigan prostatectomy original description in 1990, to recent reports of robotic-assisted surgery using this urethra-sparing technique, many studies have suggested the advantages of the preservation of urethra, bladder neck and ejaculatory ducts, when removing adenomatous tissue in benign prostatic obstruction (BPO) surgery. Allying anatomical preservation of this structure with the well known benefits of minimally invasive procedures seems to reduce postoperative haematuria, obviating the need for bladder irrigation, with shorter catheterization and hospitalization times, less risk of urethral stricture and, of utmost importance, reducing rates of retrograde ejaculation. SUMMARY Urethra and bladder neck sparing techniques, especially in minimally invasive simple prostatectomy procedures, seem to provide real benefits, not only in the maintenance of preoperative potency and antegrade ejaculation but also accomplishing better perioperative outcomes, with faster patient recovery, and less complications. These techniques might well be the future standard techniques for sexually active men with large benign prostatic hyperplasia (BPH) requiring surgery.
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Affiliation(s)
- Andreia Cardoso
- Life and Health Sciences Research Institute, ICVS/3B's - Associate Lab. School of Medicine - University of Minho.,Urology Department, Hospital de Braga, Braga, Portugal
| | - Estevao Lima
- CUF Urology, Lisbon.,Life and Health Sciences Research Institute, ICVS/3B's - Associate Lab. School of Medicine - University of Minho
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17
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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.
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18
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Destefanis P, Sibona M, Soria F, Vercelli E, Vitiello F, Bosio A, Bisconti A, Lillaz B, Gontero P. Ejaculation-sparing versus non-ejaculation-sparing anatomic GreenLight laser enucleo-vaporization of the prostate: first comparative study. World J Urol 2021; 39:3455-3463. [PMID: 33591378 DOI: 10.1007/s00345-021-03615-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/25/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To present the step-by-step description of an ejaculation-sparing anatomic photo-selective vaporization of the prostate (PVP) technique. To report the results of a series of ejaculation-sparing versus non-ejaculation-sparing anatomic PVPs. METHODS Sexually active, benign prostatic hyperplasia (BPH) patients undergoing an anatomic PVP between 11/2018 and 2/2020 were included. Patients were divided into group A (ejaculation-sparing surgery) and group B (control group). Baseline, peri-operative and 6-months follow-up data were evaluated. Lower urinary tract symptoms (LUTS) and sexual function were assessed through internationally validated questionnaires. Groups were matched by an inverse probability of treatment weighting (IPTW) analysis. Logistic univariable regression analysis was performed to detect predictors of antegrade ejaculation preservation. RESULTS Overall, 76 patients were included, among which 15 in group A and 61 in group B. Median (inter-quartile range, IQR) age was 72 (66.5-77) years, median (IQR) prostate volume 63.5 (54.5-98.5) cc. No differences about peri-operative outcomes were detected, included high-grade complications. At 6-months follow-up, no differences in urinary or erectile function were detected between groups, while ejaculation-sparing patients showed better Male Sexual Health Questionnaire (MSHQ) scores [7 (1-13) vs. 1 (1-1), p < 0.001] and higher rates of antegrade ejaculation (60% vs. 13.1%, p < 0.001). The ejaculation-sparing technique was identified as a predictor of post-operative antegrade ejaculation (OR 19.3, CI 95% 7.2-51.2, p < 0.001). CONCLUSION The ejaculation-sparing anatomic PVP showed superiority over the control group in post-operative ejaculatory function scores and antegrade ejaculation rates. Besides, preliminary results suggested similar effectiveness in LUTS relief at a short-term follow-up.
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Affiliation(s)
- Paolo Destefanis
- Division of Urology, Department of Surgical Sciences, Molinette Hospital - A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Mattia Sibona
- Division of Urology, Department of Surgical Sciences, Molinette Hospital - A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy.
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, Molinette Hospital - A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Eugenia Vercelli
- Division of Urology, Department of Surgical Sciences, Molinette Hospital - A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Federico Vitiello
- Division of Urology, Department of Surgical Sciences, Molinette Hospital - A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Andrea Bosio
- Division of Urology, Department of Surgical Sciences, Molinette Hospital - A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Alessandro Bisconti
- Division of Urology, Department of Surgical Sciences, Molinette Hospital - A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Beatrice Lillaz
- Division of Urology, Department of Surgical Sciences, Molinette Hospital - A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, Molinette Hospital - A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
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Which Anatomic Structures Should Be Preserved During Aquablation Contour Planning to Optimize Ejaculatory Function? A Case-control Study Using Ultrasound Video Recordings to Identify Surgical Predictors of Postoperative Anejaculation. Urology 2021; 153:250-255. [PMID: 33482130 DOI: 10.1016/j.urology.2021.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To identify key anatomic structures that should be preserved to decrease postoperative anejaculation after Aquablation. METHODS We conducted a case-control study design using patient data and operative video logs from Aquablation clinical trials. Cases were sexually active participants with functional baseline ejaculation and postoperative anejaculation. Controls were sexually active participants with functional baseline ejaculation and no postoperative decline in sexual function. Each case was matched to 1 or 2 controls. Video logs from the procedure were scored for: verumontanum cut coverage, penetration of ejaculatory ducts, depth of cut below the verumontanum, angle offset of verumontanum to centerline of protection zone, number of passes, and intraprostatic calcifications. Conditional logistic regression was used to calculate univariate odds ratios relating anatomic findings to case/control status. RESULTS We identified 24 cases and 27 controls. In univariate analysis, predictors of postoperative anejaculation were: penetration of the ejaculatory ducts (odds ratio [OR] 8.6 [95% CI 1.09-67.5], P = .041) and depth below the verumontanum (OR 1.92 [1.1-3.3], P = .015). CONCLUSION Violation of anatomic structures involved in ejaculation during the Aquablation procedure increases the risk of postoperative anejaculation. More careful attention to these structures during contour planning may further improve ejaculatory function after Aquablation.
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20
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Bebi C, Turetti M, Lievore E, Ripa F, Bilato M, Rocchini L, Gallioli A, Spinelli MG, De Lorenzis E, Albo G, Longo F, Gadda F, Dell'Orto PG, Montanari E, Boeri L. Sexual and ejaculatory function after holmium laser enucleation of the prostate and bipolar transurethral enucleation of the prostate: a single-center experience. Int J Impot Res 2020; 34:71-80. [PMID: 33082545 DOI: 10.1038/s41443-020-00366-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/29/2020] [Accepted: 10/09/2020] [Indexed: 12/20/2022]
Abstract
Currently available surgical treatments for Lower Urinary Tract Symptoms (LUTS) due to Benign Prostatic Obstruction (BPO) are associated with an increased risk of sexual dysfunction. The aim of our study is to compare sexual and ejaculatory function after Holmium Laser Enucleation of the Prostate (HoLEP) and Bipolar Transurethral Enucleation of the Prostate (B-TUEP). We performed a retrospective analysis of data prospectively collected from 62 (44.9%) and 76 (55.1%) patients who underwent HoLEP and B-TUEP, respectively. Erectile function and ejaculation characteristics were assessed with the International Index of Erectile Function-Erectile Function (IIEF-EF) domain and the Male Sexual Health Questionnaire-Ejaculatory function (MSHQ-EJ) questionnaires. Our study recorded no change in erectile function and no significant difference in rates of preserved antegrade ejaculation after both surgeries. One month after surgery, rates of physical pain/discomfort and perceived decreased physical pleasure during ejaculation were higher in HoLEP than B-TUEP patients (all p < 0.03). Moreover, HoLEP patients were more bothered by their ejaculatory difficulties than B-TUEP men (p = 0.03). At 3- and 12-months follow-up, all ejaculation-related differences disappeared. In conclusion, both procedures are valid alternatives for BPO treatment as they offer comparable urinary and sexual outcomes in the long term. However, in the first month after surgery, HoLEP patients present with more ejaculatory difficulties.
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Affiliation(s)
- Carolina Bebi
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Matteo Turetti
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Elena Lievore
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Francesco Ripa
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Marco Bilato
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Lorenzo Rocchini
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Andrea Gallioli
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Matteo Giulio Spinelli
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Elisa De Lorenzis
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giancarlo Albo
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Fabrizio Longo
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Franco Gadda
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Guido Dell'Orto
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
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Bozzini G, Berti L, Maltagliati M, Besana U, Calori A, Müller A, Sighinolfi MC, Micali S, Pastore AL, Ledezma R, Broggini P, Rocco B, Buizza C. Ejaculation-sparing thulium laser enucleation of the prostate (ES-ThuLEP): outcomes on a large cohort. World J Urol 2020; 39:2029-2035. [PMID: 32929626 DOI: 10.1007/s00345-020-03442-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/05/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess the effects of a new ejaculation-sparing thulium laser enucleation of the prostate (ES-ThuLEP) technique on sexual functions and micturition, in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) and to evaluate how the surgical technique of ES-ThuLEP can lead to ejaculation preservation. METHODS A prospective study was carried out between January 2015 and January 2018 on patients with surgical indication for BPH, who wished to preserve ejaculation. The patients were treated with ES-ThuLEP and were evaluated before and 3 and 6 months after surgery. Three validated questionnaires (ICIQ-MLUTSsex, IIEF-5 and IPSS) were used to assess changes in ejaculation, erectile function and urinary symptoms. Uroflowmetry (Qmax and Qavg), post-void residual volume and voided volume were also evaluated, to assess micturition improvement. Patients with moderate to severe erectile dysfunction were excluded. Statistical analysis was performed with the Student's t test, Chi-square test and logistic regression analysis. RESULTS Two hundred and eighty three patients were enrolled. Ejaculation was spared in 203 and 219 patients at 3 and 6 months after surgery. No significant differences were observed between erectile function before and after surgery: baseline IIEF-5 = 16.2 ± 4.47 vs 16.7 ± 2.9 (p = 0.419) and 17.7 ± 3.2 (p = 0.410) at 3 and 6 months. Significant improvement in urinary symptoms was achieved: baseline IPSS = 19.4 ± 7.24 vs 5.8 ± 4.3 (p = 0.032) and 3.9 ± 4.1 (p = 0.029) at 3 and 6 months. CONCLUSION ES-ThuLEP effectively preserved ejaculation in over two thirds of the patients without compromising micturition improvement or erectile function. ES-ThuLEP could be a valid treatment option for BPH in young and sexually active men.
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Affiliation(s)
- Giorgio Bozzini
- Department of Urology, ASST Valle Olona, Ospedale di Busto Arsizio (VA), Busto Arsizio, Italy.
| | - Lorenzo Berti
- Department of Urology, ASST Valle Olona, Ospedale di Busto Arsizio (VA), Busto Arsizio, Italy
- Department of Urology, Università degli Studi di Modena e Reggio Emilia (MO), Modena, Italy
| | - Matteo Maltagliati
- Department of Urology, ASST Valle Olona, Ospedale di Busto Arsizio (VA), Busto Arsizio, Italy
- Department of Urology, Università degli Studi di Modena e Reggio Emilia (MO), Modena, Italy
| | - Umberto Besana
- Department of Urology, ASST Valle Olona, Ospedale di Busto Arsizio (VA), Busto Arsizio, Italy
| | - Alberto Calori
- Department of Urology, ASST Valle Olona, Ospedale di Busto Arsizio (VA), Busto Arsizio, Italy
| | | | | | - Salvatore Micali
- Department of Urology, Università degli Studi di Modena e Reggio Emilia (MO), Modena, Italy
| | | | - Rodrigo Ledezma
- Department of Urology, Hospital Clìnico Universidad de Chile, Santiago, Chile
| | - Paolo Broggini
- Department of Urology, Clinica Sant'Anna, Lugano, Switzerland
| | - Bernardo Rocco
- Department of Urology, Università degli Studi di Modena e Reggio Emilia (MO), Modena, Italy
| | - Carlo Buizza
- Department of Urology, ASST Valle Olona, Ospedale di Busto Arsizio (VA), Busto Arsizio, Italy
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22
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Perioperative and 1-year patient-reported outcomes of Freyer versus Millin versus Madigan robot-assisted simple prostatectomy. World J Urol 2020; 39:2005-2010. [PMID: 32728883 DOI: 10.1007/s00345-020-03391-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/23/2020] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Robotic-assisted simple prostatectomy (RASP) is an established surgical procedure for the management of obstructive symptoms caused by large adenomas. Traditionally, this is performed according to the trans-vescical (Freyer) or trans-capsular (Millin) technique. We recently described a novel urethra-sparing (Madigan) robotic technique which showed promising preliminary results. In this study, we compared the above techniques for perioperative and 1-year patient-reported outcomes. METHODS We retrospectively collected data from patients who underwent RASP across the three techniques, performed by two experienced surgeons in our center. We assessed patient self-reported pre-operative and post-operative functional outcomes with validated questionnaires: IPSS, IIEF short form, ICIQ short form, MSHQ Short Form. Continuous and categorical variables were compared between groups using the Mood's median test and the Chi-square tests, respectively. RESULTS Millin, Madigan and Freyer procedures were performed in 23 (51%), 14 (31%) and 8 (18%) cases, respectively. No significant differences were observed for baseline ASA score, BMI, prostate volume, IPSS, IIEF, ICIQ and MSHQ scores (all p ≥ 0.2), as well as post-operative obstructive symptoms relief (IPSS: p = 0.25), continence (ICIQ: p = 0.54), complication rates (p = 0.32) and hospital stay (p = 0.23). Operative time was longer for Madigan procedures (p = 0.05). The 1-year MSHQ and IIEF scores were significantly higher in the Madigan cohort (p = 0.008 and p = 0.04, respectively). CONCLUSION RASP proved to be a safe surgical approach, providing an effective and durable relief of obstructive symptoms at mid-term follow-up regardless of the technique used. The Madigan technique provided significant benefits in terms of self-assessed quality of sexual function.
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23
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Cheng BKC, Li TCF, Yu CHT. Sexual outcomes of endoscopic enucleation of prostate. Andrologia 2020; 52:e13724. [PMID: 32557813 DOI: 10.1111/and.13724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/24/2020] [Accepted: 05/30/2020] [Indexed: 12/28/2022] Open
Abstract
The emergence of various endoscopic enucleation techniques in the past decade has provided surgeons with more options and opportunities in performing enucleation. With the same surgical principle as holmium laser enucleation of prostate, the early results of different techniques were comparable. However, sexual outcomes of endoscopic enucleation of the prostate (EEP) were less commonly reported than the voiding and urodynamic outcomes. In this review, the sexual outcomes including erectile function, ejaculatory and orgasmic function of various endoscopic enucleation technique would be studied. The overall sexual outcomes were heterogeneous and inconclusive. Outcomes measurement, sample size calculation, hypothesis generation and selection criteria were not specifically designed for sexual outcomes or even available. There were also limitations in the individual sexual assessment tools. Nonetheless, most studies showed no significant deterioration of erectile function after EEP, and ejaculation dysfunction was common. Looking forward in the field of benign prostatic enlargement surgery, the 'one size fits all' notion should be abandoned. Treatment should be tailor-made according to the prostate size, co-morbidities and sexual needs. The sexual outcomes of enucleation have to be better studied and defined. More prospective controlled studies focusing primarily on sexual functions are needed. For enucleation surgeons, exploring different ejaculatory-sparing technique could be the golden opportunities in further consolidating the role and expanding the indication of enucleation surgery.
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Affiliation(s)
| | | | - Chloe Hui-Tung Yu
- Department of Surgery, United Christian Hospital, Hong Kong, Hong Kong
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24
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Herrmann TR, Gravas S, de la Rosette JJMCH, Wolters M, Anastasiadis AG, Giannakis I. Lasers in Transurethral Enucleation of the Prostate-Do We Really Need Them. J Clin Med 2020; 9:E1412. [PMID: 32397634 PMCID: PMC7290840 DOI: 10.3390/jcm9051412] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/20/2020] [Accepted: 04/30/2020] [Indexed: 12/21/2022] Open
Abstract
The acronym EEP, coding for transurethral Endoscopic Enucleation of the Prostate, was introduced in 2016 by the European Association of Urology (EAU) guidelines panel on management of non-neurogenic male lower urinary tract symptoms (LUTS) and benign prostatic obstruction (BPO). Since then, a laser-based treatment, Holmium Laser Enucleation of the Prostate (HoLEP), and the current-based treatment of bipolar enucleation of the prostate (BipoLEP) are equally appreciated as valuable options for the management of benign prostatic obstruction (BPO). This was mainly inspired by the results of two meta-analyses on randomized controlled trials, comparing open prostatectomy with either Holmium Laser Enucleation of the Prostate (HoLEP) or bipolar enucleation of the prostate (BipoLEP). Prior to that, HoLEP was embraced as the only valid option for transurethral enucleation, although evidence for equivalence existed as early as 2006, but was not recognized due to a plethora of acronyms for bipolar energy-based treatments and practiced HoLEP-centrism. On the other hand, the academic discourse focused on different (other) laser approaches that came up, led by Thulium:Yttrium-Aluminum-Garnet (Tm:YAG) Vapoenucleation (ThuVEP) in 2009 and, finally, transurethral anatomical enucleation with Tm:YAG support (thulium laser enucleation of the prostate, ThuLEP) in 2010. Initially, the discourse on lasers focused on the different properties of lasers rather than technique or surgical anatomy, respectively. In and after 2016, the discussion ultimately moved towards surgical technique and accepting anatomical preparation as the common of all EEP techniques (AEEP). Since then, the unspoken question has been raised, whether lasers are still necessary to perform EEP in light of existing evidence, given the total cost of ownership (TCO) for these generators. This article weighs the current evidence and comes to the conclusion that no evidence of superiority of one modality over another exists with regard to any endpoint. Therefore, in the sense of critical importance, AEEP can be safely and effectively performed without laser technologies and without compromise.
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Affiliation(s)
- Thomas R.W. Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, 8569 Münsterlingen, Switzerland; (A.G.A.); (I.G.)
- Department of Urology, Hannover Medical School, 30625 Hannover, Germany;
| | - Stavros Gravas
- Department of Urology, University Hospital of Larisa, 41500 Larisa, Greece;
| | | | - Mathias Wolters
- Department of Urology, Hannover Medical School, 30625 Hannover, Germany;
| | | | - Ioannis Giannakis
- Department of Urology, Spital Thurgau AG, Frauenfeld, 8569 Münsterlingen, Switzerland; (A.G.A.); (I.G.)
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25
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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.
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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
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26
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Herrmann TRW, Wolters M. Transurethral anatomical enucleation of the prostate with Tm:YAG support (ThuLEP): Evolution and variations of the technique. The inventors' perspective. Andrologia 2020; 52:e13587. [PMID: 32286719 DOI: 10.1111/and.13587] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/20/2020] [Indexed: 12/27/2022] Open
Abstract
After its introduction, transurethral anatomical enucleation of the prostate with Tm:YAG support (ThuLEP) has evolved as one of the standard techniques of transurethral anatomical endoscopic enucleations of the prostate. Growing evidence has proven ThuLEP as an alternative for the treatment of bladder outlet obstruction caused by benign prostatic enlargement and has been acknowledged by the EAU Guidelines on Management of Non-Neurogenic Male Lower Urinary Tract Symptoms, incl. Benign Prostatic Obstruction. The uniqueness of ThuLEP as a concept made it a blueprint for other laser and nonlaser enucleating techniques based on the emphasis on two principles: widely blunt anatomical dissection and demystification of energy sources as being secondary for transurethral enucleation. The original technique has been technically refined by the inventor and other working groups in the field. The evolutionary modifications followed the academic discourse on anatomical enucleation for measures to prevent early postoperative stress urinary incontinence and preservation of antegrade ejaculation. Variations of the original three-lobe dissection technique were introduced with two-lobe approach or en bloc dissection. The manuscript is accompanied by an instructional video and surgical atlas on the currently most commonly applied two-lobe technique.
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Affiliation(s)
- Thomas R W Herrmann
- Department of Urology, Spital Thurgau AG (STGAG), Frauenfeld, Switzerland.,Department of Urology and Urological Oncology, Hanover Medical School (MHH), Hanover, Germany
| | - Mathias Wolters
- Department of Urology and Urological Oncology, Hanover Medical School (MHH), Hanover, Germany
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Mathangasinghe Y, Samaranayake UMJE, Dolapihilla BN, Anthony DJ, Malalasekera AP. Morphology of ejaculatory ducts: A systematic review. Clin Anat 2020; 33:1164-1175. [PMID: 31894887 DOI: 10.1002/ca.23557] [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: 09/17/2019] [Revised: 12/05/2019] [Accepted: 12/28/2019] [Indexed: 01/21/2023]
Abstract
The morphology of human ejaculatory ducts has not been well established. The objective of this study was to describe macroscopic and microscopic anatomy of ejaculatory ducts. We conducted a systematic review using MEDLINE, Scopus, PubMed, and Cochrane databases. Search terms were: "ejaculatory ducts," "seminal colliculus," "prostatic utricle," "anatomy," "histology," "radiology," and "embryology." We only included studies assessing adult (>18 years) humans published before November 1, 2019. We excluded studies describing pathological ducts and case reports. Independent authors extracted data using predefined criteria. Fourteen studies were included in the qualitative synthesis. Usually, the ejaculatory ducts entered the prostate by piercing the central part of its base. Most studies identified an anteromedial curve of the ducts at the outset within the prostate, their subsequent course being a straight path towards the seminal colliculus, their terminal parts diverging immediately before joining the prostatic urethra. However, the morphology of the terminal part of the ducts was inconsistent. The mean length of the ducts ranged from 1.4 to 2.2 cm. In conclusion, the luminal diameter gradually decreased as the ducts traveled towards the seminal colliculus. Ejaculatory ducts angulate anteromedially at their onset within the prostate and travel straight towards the seminal colliculus. Their terminal parts diverge immediately before joining the prostatic urethra. However, the reported dimensions of the ducts differ among studies.
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Affiliation(s)
- Yasith Mathangasinghe
- Department of Anatomy, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | | | - Dimonge J Anthony
- Department of Anatomy, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Ajith P Malalasekera
- Department of Anatomy, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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28
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Morton S, McGuiness L, Harding C, Thorpe A. A review of surgery and new technology procedures for the management of benign prostatic obstruction. JOURNAL OF CLINICAL UROLOGY 2019. [DOI: 10.1177/2051415819879667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Level of evidence: Not applicable for this review article.
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Affiliation(s)
- Simon Morton
- Department of Urology Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Luke McGuiness
- Department of Urology Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Christopher Harding
- Department of Urology Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Andrew Thorpe
- Department of Urology Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
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29
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Holmium Laser Enucleation of the Prostate: Modified Two-Lobe Technique versus Traditional Three-Lobe Technique-A Randomized Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3875418. [PMID: 31662976 PMCID: PMC6791212 DOI: 10.1155/2019/3875418] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/29/2019] [Accepted: 09/06/2019] [Indexed: 01/23/2023]
Abstract
Background Holmium laser enucleation of the prostate (HoLEP) is considered the standard endoscopic treatment of benign prostatic hyperplasia (BPH), but traditional HoLEP surgery will cause some postoperative complications. This study was attempted to evaluate the safety and efficacy of modified two-lobe technique versus traditional three-lobe technique of HoLEP focusing mainly on incidences of retrograde ejaculation (RE) and urinary incontinence (UI). Methods From March 2014 to February 2017, 191 men with BPH were randomly assigned to two groups: 97 underwent modified two-lobe technique; 94 underwent traditional three-lobe technique. All patients were followed up for 12 months. Primary outcomes were incidences of RE and UI, and secondary outcomes were international prostate symptom score (IPSS), quality of life (QOL), maximal urine flowing rate (MFR), and residual urine among the studied patients. Results Compared with the traditional technique, patients in the modified group had a statistically significant decrease in frequency of UI (1.03% vs 8.51%, p=0.036) and RE in the 6th month (33.33% vs 63.64%, p=0.030) and 12th month (13.33% vs 50%, p=0.034) and a significant increase in ejaculatory volume in the 6th month (p=0.050) and 12th month (p=0.003). Besides, the modified HoLEP was more beneficial to patients according to the change of QoL score at 1 month (p=0.002), 3 months (p=0.004), 6 months (p=0.026), and 12 months (p=0.015). Conclusions The modified two-lobe technology of HoLEP reduced the incidence of RE and UI, which improved the quality of life of the patients after surgery compared to the traditional three-lobe technology. This trial is registered with ChiCTR1800018553.
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30
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Cacciamani GE, Cuhna F, Tafuri A, Shakir A, Cocci A, Gill K, Gómez Rivas J, Dourado A, Veneziano D, Okhunov Z, Capogrosso P, Hueber PA, Alberseen M, Abreu A, Migliorini F, Fiori C, Porcaro AB, Porpiglia F, Desai M, Russo GI. Anterograde ejaculation preservation after endoscopic treatments in patients with bladder outlet obstruction: systematic review and pooled-analysis of randomized clinical trials. MINERVA UROL NEFROL 2019; 71:427-434. [PMID: 31487977 DOI: 10.23736/s0393-2249.19.03588-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Despite the high rate of resolution, ejaculatory dysfunction still is the most common side effect related to surgical treatment of bladder outlet obstruction (BOO). The aim of the present systematic review was to compare several technological treatment modalities for the management of lower urinary tract symptoms/BOO in terms of functional and sexual outcomes. EVIDENCE ACQUISITION All English language randomized controlled trials assessing the impact of different endoscopic treatments for BOO were evaluated. We followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement to evaluate PubMed®, Scopus®, and Web of Science™ databases (up to June 2019). EVIDENCE SYNTHESIS Our electronic search identified a total of 2221 papers in PubMed, Scopus, and Web of Science. Of these, 142 publications were identified for detailed review, which yielded 21 included in the present systematic review. All groups appeared similar with regards to preoperative IPSS/AUA Score, Qmax, and prostate volume (cc). Patients undergoing endoscopic treatments using ThuLEP, Greenlight or Prostate Artery Embolization techniques had lower-but not statistically significant- relative risk (RR) of retrograde ejaculation compared with conventional transurethral resection of the prostate (TURP) (RR: 0.90; P=0.35; RR: 0.71; P=0.1; RR0.73; P=0.11). Efficacy of those techniques was equal to TURP. CONCLUSIONS Data reporting anterograde ejaculation preservation after endoscopic treatment in patients with benign prostatic enlargement are sparse and heterogeneous. Pooled analyses suggest that new technological alternatives to conventional TURP might improve sexual outcomes, especially for non-ablative treatments.
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Affiliation(s)
- Giovanni E Cacciamani
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA -
| | - Frederico Cuhna
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA
| | - Alessandro Tafuri
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA.,Department of Urology, University of Verona, Verona, Italy
| | - Aliasger Shakir
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA
| | - Andrea Cocci
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Karanvir Gill
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA
| | | | - Aurus Dourado
- Department of Urology, São Marcos Hospital, Piauí, Brazil
| | - Domenico Veneziano
- Department of Urology and Renal Transplantation, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, CA, USA
| | | | - Pierre A Hueber
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA
| | - Marteen Alberseen
- Department of Urology and Pediatric Urology, Medicine University Mainz, Mainz, Germany
| | - Andre Abreu
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA
| | | | - Cristian Fiori
- Department of Urology, San Luigi Hospital, University of Turin, Turin, Italy
| | | | - Francesco Porpiglia
- Department of Urology, San Luigi Hospital, University of Turin, Turin, Italy
| | - Mihir Desai
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA
| | - Giorgio I Russo
- Department of Urology, University of Catania, Catania, Italy
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31
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Abstract
This review provides a brief overview of and commentary on currently available technology for the surgical treatment of obstructive benign prostatic hyperplasia causing lower urinary tract symptoms. This review provides references relevant to review and understand current technology that is clinically available.
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Affiliation(s)
- Alexis E Te
- Weill Medical College of Cornell University, Ithaca, NY, USA.,Urology Program, Iris Cantor Men's Health Center, 425 East 61st Street, 12th Floor, New York, NY, 10065, USA.,Brady Prostate Center and Urodynamics Laboratory, 525 East 68th Street, 9th Floor, New York, NY, 10065, USA
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32
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Leong JY, Patel AS, Ramasamy R. Minimizing Sexual Dysfunction in BPH Surgery. CURRENT SEXUAL HEALTH REPORTS 2019; 11:190-200. [PMID: 31467497 DOI: 10.1007/s11930-019-00210-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose of Review To review the prevalence and risks of sexual dysfunction associated with current treatment options for benign prostatic hyperplasia and to characterize techniques and methods to manage postoperative sexual dysfunction-related side effects. Recent Findings Current surgical therapies available for the treatment of benign prostatic hyperplasia are associated with a substantial risk of both ejaculatory and erectile function. However, many of the novel minimally invasive treatment alternatives have demonstrated the ability to preserve postoperative sexual function to a better degree, all while providing significant relief of lower urinary tract symptoms in an equally safe and efficacious manner. Summary Benign prostatic hyperplasia remains a highly prevalent disease among the aging population. While surgical treatments are often necessary to relieve bothersome urinary symptoms, these procedures are associated with an increased risk of sexual dysfunction. As such, there has been an increased interest in the development of minimally invasive therapies, such as the UroLift®, Rezum®, and Aquablation®, with the hopes of achieving similar symptomatic relief while maintaining sexual function. Aside from reporting lower rates of sexual dysfunction, these procedures have also demonstrated comparable safety, durability, and efficacy to current gold standard therapies. Some procedures can even be performed in an outpatient setting, avoiding the need for general anesthesia altogether. Overall, an individualized, shared decision-making approach is necessary to determine the ideal treatment option for each patient.
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Affiliation(s)
- Joon Yau Leong
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut Street, College Building, Suite 1112, Philadelphia, PA 19107, USA
| | - Amir S Patel
- Department of Urology, Oregon Health and Science University, Portland, OR, USA
| | - Ranjith Ramasamy
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
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Abstract
PURPOSE OF REVIEW To explore the potential applicability of a novel, heat-free, and robotically controlled ablative therapy for surgical management of benign prostatic enlargement. RECENT FINDINGS With the emergence of new technology to provide personalized care and overcome the complications associated with options such as TURP, holmium laser enucleation of the prostate, GreenLight laser, or simple prostatectomy, Aquablation has been studied across a variety of prostate volumes. The functional outcome of Aquablation seems to be uncompromised by prostate volume. The sexual profile seems superior to TURP and the risk of retrograde ejaculation is lower. The robotic system provides a reproducible ablation, independent of prostate volume, without requiring extensive training for performing the procedure. The mean ablation time in the prostate as large as 150 ml does not exceed 9.1 min, and the blood transfusion rates do not seem to be higher than open prostatectomy.
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Affiliation(s)
- Hossein Saadat
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
- Toronto Western Hospital, 399 Bathurst Street, MP-8-317, Toronto, Ontario, M5T 2S8, Canada
| | - Dean S Elterman
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Canada.
- Toronto Western Hospital, 399 Bathurst Street, MP-8-317, Toronto, Ontario, M5T 2S8, Canada.
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34
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Urethra and Ejaculation Preserving Robot-assisted Simple Prostatectomy: Near-infrared Fluorescence Imaging-guided Madigan Technique. Eur Urol 2019; 75:492-497. [DOI: 10.1016/j.eururo.2018.11.051] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/28/2018] [Indexed: 12/27/2022]
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35
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Do patients have to choose between ejaculation and miction? A systematic review about ejaculation preservation technics for benign prostatic obstruction surgical treatment. World J Urol 2018; 37:299-308. [DOI: 10.1007/s00345-018-2368-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/04/2018] [Indexed: 12/11/2022] Open
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36
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Rieken M, Antunes-Lopes T, Geavlete B, Marcelissen T. What Is New with Sexual Side Effects After Transurethral Male Lower Urinary Tract Symptom Surgery? Eur Urol Focus 2018; 4:43-45. [PMID: 29803559 DOI: 10.1016/j.euf.2018.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/25/2018] [Accepted: 05/03/2018] [Indexed: 10/16/2022]
Abstract
Transurethral resection of the prostate as well as laser prostatectomy (by either holmium laser enucleation of the prostate or Greenlight laser vaporization) is associated with risks of sexual dysfunction such as antegrade ejaculation and occasionally erectile dysfunction. While ejaculation-sparing variations of these techniques show promising results, larger multicenter studies are needed to confirm promising data. Prostatic urethral lift maintains erectile and ejaculatory function at 5-yr follow-up. The same is true for the 3-yr data on the Rezum system. Recently, Aquablation has shown promising results; however, these 6-mo data need to be confirmed during longer follow-up. An individualized, shared decision-making process based on clinical parameters and patient preference is warranted to select the ideal treatment option for each patient. PATIENT SUMMARY Sexual dysfunction such as loss of ejaculation and, less frequently, erectile dysfunction can occur after transurethral prostate surgery. Ejaculation-sparing modifications as well as minimally invasive alternatives show promising results. An individualized approach is warranted to select the ideal technique for each patient.
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Affiliation(s)
- Malte Rieken
- alta uro AG, Basel, Switzerland; University Basel, Basel, Switzerland.
| | - Tiago Antunes-Lopes
- Hospital de S. João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Bogdan Geavlete
- Department of Urology, "Saint John" Emergency Clinical Hospital, Bucharest, Romania; "Carol Davila" University of Medicine, Bucharest, Romania
| | - Tom Marcelissen
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Urologists’ attitudes to sexual complications of LUTS/BPH treatments. World J Urol 2018; 36:1449-1453. [DOI: 10.1007/s00345-018-2283-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 03/28/2018] [Indexed: 11/27/2022] Open
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Malalasekera AP, Sivasuganthan K, Sarangan S, Thaneshan K, Weerakoon DN, Mathangasinghe Y, Gunasekera CL, Mallawaarachchi S, Nanayakkara ND, Anthony DJ, Ediriweera D. Morphological variations of the human ejaculatory ducts in relation to the prostatic urethra. Clin Anat 2018; 31:456-461. [PMID: 29226429 DOI: 10.1002/ca.23036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/22/2017] [Accepted: 12/07/2017] [Indexed: 11/05/2022]
Abstract
Loss of ejaculation can follow transurethral resection of the prostate (TURP). Periverumontanal prostate tissue is preserved in ejaculation-preserving TURP (ep-TURP). Knowledge of ejaculatory duct anatomy in relation to the prostatic urethra can help in ep-TURP. This was evaluated in cross-sections of the prostate using a 3 D model to determine a safe zone for resecting the prostate in ep-TURP. A 3 D reconstruction of the ejaculatory ducts was developed on the basis of six prostate gland cross-sections. The measurements obtained from the 3 D model were standardized according to the maximum width of the prostate. Simple linear regressions were used to predict the relationships of the ejaculatory ducts. The maximum widths of the prostates ranged from 22.60 to 52.10 mm. The ejaculatory ducts entered the prostate with a concavity directed posterolaterally. They then proceeded toward the seminal colliculus in a fairly straight course, and from that point they angulated anteromedially. As they opened into the prostatic urethra they diverged. Significant regression models predicted the relationships of the ejaculatory ducts to the prostatic urethra based on the sizes of the prostates. The 3 D anatomy of ejaculatory ducts can be predicted on the basis of prostate width. The ejaculatory ducts can be preserved with 95% accuracy if a block of tissue 7.5 mm from the midline on either side of the seminal colliculus is preserved, up to 10 mm proximal to the level of the seminal colliculus, during TURP. Clin. Anat. 31:456-461, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
| | - K Sivasuganthan
- Department of General Surgery, Teaching Hospital Jaffna, Sri Lanka
| | - S Sarangan
- Department of General Surgery, Teaching Hospital Karapitiya, Sri Lanka
| | - K Thaneshan
- Department of Anesthesia, Teaching Hospital Jaffna, Sri Lanka
| | - D N Weerakoon
- Department of Anatomy, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Y Mathangasinghe
- Department of Anatomy, Faculty of Medicine, University of Colombo, Sri Lanka
| | | | - Sudaraka Mallawaarachchi
- Advanced Computing and Simulation Laboratory, Department of Electrical and Computer Systems Engineering, Monash University, Australia
| | | | - D J Anthony
- Department of Anatomy, Faculty of Medicine, University of Colombo, Sri Lanka
| | - D Ediriweera
- Computer Centre, Faculty of Medicine, University of Kelaniya, Sri Lanka
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Shigemura K, Fujisawa M. Current status of holmium laser enucleation of the prostate. Int J Urol 2017; 25:206-211. [PMID: 29205507 DOI: 10.1111/iju.13507] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 09/26/2017] [Indexed: 02/01/2023]
Abstract
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.
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Affiliation(s)
- Katsumi Shigemura
- Department of Urology, Kobe University Hospital, Kobe, Japan.,Department of International Health, Kobe University Graduate School of Health Sciences, Kobe, Japan.,Department of Infection Control and Prevention, Kobe University Hospital, Kobe, Japan
| | - Masato Fujisawa
- Department of Urology, Kobe University Hospital, Kobe, Japan
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Marien T, Kadihasanoglu M, Miller NL. Holmium laser enucleation of the prostate: patient selection and perspectives. Res Rep Urol 2016; 8:181-192. [PMID: 27800470 PMCID: PMC5085273 DOI: 10.2147/rru.s100245] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Multiple endoscopic surgical options exist to treat benign prostatic hyperplasia (BPH), including holmium laser enucleation of the prostate (HoLEP). HoLEP alleviates obstructive prostatic tissue via enucleation, both bluntly with a resectoscope and by cutting tissue with the holmium laser, and removal of adenoma via morcellation. This article reviews patient selection for HoLEP in order to optimize outcomes, costs, and patient satisfaction. Methods A literature review of all studies on HoLEP was conducted. Studies that focused on outcomes in regard to patient and procedural factors were closely reviewed and discussed. Results Various studies found that men with large or small prostates, on antithrombotic therapy, in urinary retention, with bladder hypocontractility, with prostate cancer, undergoing retreatment for BPH, or in need of concomitant surgery for bladder stones and other pathologies do well with HoLEP, as demonstrated by excellent functional and symptomatic outcomes as well as low complication rates. There is a 74–78% rate of retrograde ejaculation following HoLEP. Techniques to preserve ejaculatory function following enucleative techniques have not been able to demonstrate a significant improvement. Conclusion Patient selection for HoLEP can include most men with bothersome BPH who have evidence of bladder outlet obstruction and are healthy enough to undergo surgery. The ability to safely perform concomitant surgery with HoLEP benefits the patient by sparing them an additional anesthetic and also decreases costs. Patients should be made aware of the risk of retrograde ejaculation following HoLEP and counseled on treatment alternatives if maintaining ejaculatory function is desired.
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Affiliation(s)
- Tracy Marien
- Department of Urology, Vanderbilt Medical Center, Nashville, TN, USA
| | | | - Nicole L Miller
- Department of Urology, Vanderbilt Medical Center, Nashville, TN, USA
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Patient Perception of Ejaculatory Volume Reduction After Holmium Laser Enucleation of the Prostate (HoLEP). Urology 2016; 99:142-147. [PMID: 27725232 DOI: 10.1016/j.urology.2016.09.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 12/13/2022]
Abstract
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.
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DeLay KJ, Nutt M, McVary KT. Ejaculatory dysfunction in the treatment of lower urinary tract symptoms. Transl Androl Urol 2016; 5:450-9. [PMID: 27652217 PMCID: PMC5002000 DOI: 10.21037/tau.2016.06.06] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The link between lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) and sexual dysfunction is well established. Sexual dysfunction can encompass both ejaculatory dysfunction (EjD) and erectile dysfunction (ED). Ejaculatory dysfunction can consist of premature ejaculation, delayed ejaculation, retrograde ejaculation, anejaculation, decreased force of ejaculation and pain upon ejaculation. The impact of different medical and surgical therapies on ejaculatory function will be reviewed. We reviewed the various categories of LUTS treatment including the canonical epidemiology and pathophysiology as well as the surgical and medical treatments for LUTS/BPH. We note that most surgeries and several medical treatments have a certain but ill-defined negative impact on ejaculatory function. Several MISTs and selected medical therapies appear to have little impact on EjD. Both EjD and BPH are very common disorders in men under the care of an urologist. It is well documented that there is a clinical association between these two entities. Unfortunately many of the medical treatments and almost all surgical treatment impact the ejaculatory function of the patient. The surgical treatment of BPH often leads to retrograde ejaculation while medical treatment leads to anejaculation.
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Affiliation(s)
- Kenneth Jackson DeLay
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Max Nutt
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Kevin T McVary
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
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Preservation of sexual function when relieving benign prostatic obstruction surgically. Curr Opin Urol 2016; 26:42-8. [DOI: 10.1097/mou.0000000000000247] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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