1
|
Mykoniatis I, Renterghem KV, Sokolakis I. How can we Preserve Sexual Function after Ablative Surgery for Benign Prostatic Hyperplasia? Curr Drug Targets 2020; 22:4-13. [PMID: 32981500 DOI: 10.2174/1389450121666200925143916] [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: 03/08/2020] [Revised: 05/28/2020] [Accepted: 07/08/2020] [Indexed: 12/22/2022]
Abstract
Our aim was to provide a narrative review regarding the prevalence, the associated pathophysiologic pathways and the potential management methods of sexual dysfunction related to ablative surgical techniques for Benign Prostatic Enlargement (BPE). Men suffering from BPE are at high risk of sexual dysfunction due to the disease itself, comorbidities, and pharmacological/surgical treatments. Transurethral resection of the prostate, as the gold standard treatment option for BPE, has historically been associated with relatively high rates of postoperative sexual dysfunction problems, mainly retrograde ejaculation but also erectile dysfunction. Ablative surgical techniques, including photoselective vaporization of the prostate (PVP), transurethral needle ablation (TUNA), Transurethral Microwave Therapy (TUMT), Convective Water Vapor Energy Ablation (Rezum®) and Aquablation®, have been proposed as treatment methods able to reduce treatment-related complications for BPE patients, including adverse effects on erectile and ejaculatory function, without compromising the efficacy rates for BPE. The neurovascular bundles can be damaged during TURP due to posterolateral capsular perforation. Ablative techniques and especially PVP theoretically seem to skip this hazard, as the distance created from the necrotic area to the capsule is generally larger compared to the distance induced after TURP. However, indirect thermal injury of erectile nerves, which could also be induced by the majority of available ablative techniques, could potentially lead to ED. Two special technical characteristics (physiological saline use for tissue ablation and real time penetration depth control) of Aquablation® could be proved beneficial with regard to the effect of the method on erectile function. In general, ablative techniques seem to have a minor impact on sexual function. However, low methodological quality characterizes most of the studies included in this review mainly due to the impossibility, in many cases, to perform blind randomization. Also, many studies did not have an erectile and ejaculatory function as primary outcomes limiting that way their statistical power to identify significant variations. Management of sexual dysfunction problems arising from ablative surgeries for BPE treatment could be divided into two levels. Firstly, intraoperatively the avoidance of manipulation of crucial structures regarding ejaculatory (bladder neck or ejaculatory ducts) and erectile function (neurovascular bundles) could possibly decrease the negative effect of these procedures on sexual function. Thus, in this direction, modifications of classic ablative techniques have been proposed resulting in encouraging outcomes regarding postoperative sexual function. Secondly, if EjD and/or ED are established, the already known treatment choices should be chosen in order for sexual function rehabilitation to be achieved. Thus, regarding ED: PDE5i daily or on-demand remains the gold standard first-line treatment choice followed by intracavernosal alprostadil injections in cases of failure, while penile prosthesis implantation must be kept as the final definitive solution when all the other methods have failed. Regarding ejaculation disorders (retrograde ejaculation or anejaculation): medical therapy with a-agonists (pseudoephedrine), sperm retrieval from the urine, bladder neck reconstruction, prostatic massage, electroejaculation, penile vibratory stimulation and surgical sperm retrieval are the available treatment options. Furthermore, high-quality studies are required to investigate the potential side effects of BPE surgery on sexual function and efficient treatment methods to manage them.
Collapse
Affiliation(s)
- Ioannis Mykoniatis
- Department of Urology, Jessa Hospital, Hasselt, Belgium; 2Faculty of medicine, Hasselt University, Hasselt, Belgium
| | - Koenraad Van Renterghem
- Department of Urology, Jessa Hospital, Hasselt, Belgium; 2Faculty of medicine, Hasselt University, Hasselt, Belgium
| | - Ioannis Sokolakis
- Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany
| |
Collapse
|
2
|
Tuong N, Reines K, Mikula M, Smith R. Contemporary Review of BPH Medical and Surgical Treatments on Sexual Function. CURRENT SEXUAL HEALTH REPORTS 2018. [DOI: 10.1007/s11930-018-0172-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
3
|
Pascoe C, Ow D, Perera M, Woo HH, Jack G, Lawrentschuk N. Optimising patient outcomes with photoselective vaporization of the prostate (PVP): a review. Transl Androl Urol 2017; 6:S133-S141. [PMID: 28791232 PMCID: PMC5522804 DOI: 10.21037/tau.2017.05.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Benign prostatic hyperplasia (BPH) is a common pathology causing lower urinary tract symptoms (LUTS) and may significantly impact quality of life. While transurethral resection of the prostate (TURP) remains the gold standard treatment, there are many evolving technologies that are gaining popularity. Photoselective vaporization of the prostate (PVP) is one such therapy which has been shown to be non-inferior to TURP. We aimed to review the literature and discuss factors to optimise patient outcomes in the setting of PVP for BPH. A comprehensive search of the electronic databases, including MEDLINE, Embase, Web of Science and The Cochrane Library was performed on articles published after the year 2000. After exclusion, a total of 38 papers were included for review. The evolution of higher powered device has enabled men with larger prostates and those on oral anticoagulation to undergo safely and successfully PVP. Despite continued oral anticoagulation in patients undergoing PVP, the risk of bleeding may be minimised with 5-Alpha Reductase Inhibitor (5-ARI) therapy however further studies are required. Pre-treatment with 5-ARI’s does not hinder the procedure however more studies are required to demonstrate a reliable benefit. Current data suggests that success and complication rate is largely influenced by the experience of the operator. Post-operative erectile dysfunction is reported in patients with previously normal function following PVP, however those with a degree of erectile dysfunction pre-operatively may see improvement with alleviation of LUTS.
Collapse
Affiliation(s)
- Claire Pascoe
- University of Melbourne, Department of Surgery, Austin Hospital, Melbourne, Australia.,Young Urology Researchers Organisation (YURO), Melbourne, Australia
| | - Darren Ow
- University of Melbourne, Department of Surgery, Austin Hospital, Melbourne, Australia.,Young Urology Researchers Organisation (YURO), Melbourne, Australia
| | - Marlon Perera
- University of Melbourne, Department of Surgery, Austin Hospital, Melbourne, Australia.,Young Urology Researchers Organisation (YURO), Melbourne, Australia
| | - Henry H Woo
- Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, Australia
| | - Greg Jack
- University of Melbourne, Department of Surgery, Austin Hospital, Melbourne, Australia
| | - Nathan Lawrentschuk
- University of Melbourne, Department of Surgery, Austin Hospital, Melbourne, Australia.,Olivia Newton-John Cancer Research Institute, Melbourne, Australia.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| |
Collapse
|
4
|
Carmignani L, Bozzini G, Macchi A, Maruccia S, Picozzi S, Casellato S. Sexual outcome of patients undergoing thulium laser enucleation of the prostate for benign prostatic hyperplasia. Asian J Androl 2016; 17:802-6. [PMID: 25652616 PMCID: PMC4577594 DOI: 10.4103/1008-682x.139255] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Treatment of patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) may affect the quality of sexual function and ejaculation. The effect of new surgical procedures, which are currently available to treat BPH, on erection and ejaculation, has been poorly studied. This study aimed to assess the effect of thulium laser enucleation of the prostate (ThuLEP) on sexual function and retrograde ejaculation in patients with LUTS secondary to BPH. We performed a prospective study in 110 consecutive patients who had undergone ThuLEP to analyze changes in sexual function and urinary symptoms. To evaluate changes in erection and ejaculation, and the effect of urinary symptoms on the quality of life (QoL), five validated questionnaires were used: the ICIQ-MLUTSsex, MSHQ-EjD, International Index of Erectile Function 5, International Prognostic Scoring System (IPSS) questionnaire, and QoL index of the intraclass correlation coefficients. Patients also underwent IPSS and flowmetry to assess the outcome of flow. Patients were evaluated before surgery and 3–6 months after ThuLEP, whereas those with previous abdominal surgery were excluded. The patients’ mean age was 67.83 years. Postoperative urinary symptoms improved after surgery. No significant differences in erectile function before and after surgery were observed. As compared with other techniques described in the literature, the percentage of patients with conserved ejaculation increased by 52.7% after ThuLEP. ThuLEP positively affects urinary symptoms and their effect on the QoL of patients as assessed by questionnaire scores. While endoscopic management of BPH (e.g. transurethral resection of the prostate) causes retrograde ejaculation in most patients, those who undergo ThuLEP have conserved ejaculation and erectile function.
Collapse
Affiliation(s)
- Luca Carmignani
- Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | | | | | | | | | | |
Collapse
|
5
|
Zang YC, Deng XX, Yang DR, Xue BX, Xu LJ, Liu XL, Zhou YB, Shan YX. Photoselective vaporization of the prostate with GreenLight 120-W laser versus transurethral resection of the prostate for benign prostatic hyperplasia: a systematic review with meta-analysis of randomized controlled trials. Lasers Med Sci 2015; 31:235-40. [DOI: 10.1007/s10103-015-1843-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 11/30/2015] [Indexed: 11/30/2022]
|
6
|
de la Rosette J, Elhilali M, Naito S, Unal D, Razvi H, Liatsikos E, Bachmann A, Tubaro A, Alivizatos G, Mak SK, Badlani G, Eltahawy E, Wong C, Telich Vidal M, Te A, d'Ancona F, Arum CJ, Gutierrez J. Clinical Research Office of the Endourological Society Global GreenLight Laser Study: Outcomes from a contemporary series of 713 patients. Int J Urol 2015; 22:1124-30. [DOI: 10.1111/iju.12906] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 07/23/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Jean de la Rosette
- Department of Urology; AMC University Hospital; Amsterdam The Netherlands
| | - Mostafa Elhilali
- Division of Urology; Department of Surgery; McGill University Health Centre; Montreal Quebec Canada
| | - Seiji Naito
- Department of Urology; Harasanshin Hospital; Kyushu University; Fukuoka Japan
| | - Dogan Unal
- Department of Urology; Faculty of Medicine, Hacettepe University; Ankara Turkey
| | - Hassan Razvi
- Division of Urology; Department of Surgery; Western University; London Ontario Canada
| | | | | | - Andrea Tubaro
- Department of Urology; Sant'Andrea Hospital; Rome Italy
| | | | - Siu King Mak
- Department of Surgery; North District Hospital; Hong Kong China
| | - Gopal Badlani
- Department of Urology; Wake Forest School of Medicine; Winston-Salem North Carolina USA
| | - Ehab Eltahawy
- Department of Urology; University of Arkansas for Medical Sciences; Little Rock Arkansas USA
| | - Carson Wong
- Division of Urology; University Hospitals Ahuja Medical Center; Beachwood Ohio USA
- Center for Minimally Invasive and Robotic Surgery; University Hospitals Parma Medical Center; Parma Ohio USA
- Minimally Invasive and Robotic Surgery; SouthWest Urology; LLC; Cleveland Ohio USA
| | | | - Alexis Te
- Department of Urology; Weill Medical College of Cornell University; New York New York USA
| | - Frank d'Ancona
- Department of Urology; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - Carl-Jørgen Arum
- Department of Urology; St. Olavs University Hospital; Trondheim Norway
| | - Jorge Gutierrez
- Department of Urology; Wake Forest School of Medicine; Winston-Salem North Carolina USA
| | | |
Collapse
|
7
|
Shore N. A Review of the Prostatic Urethral Lift for Lower Urinary Tract Symptoms: Symptom Relief, Flow Improvement, and Preservation of Sexual Function in Men With Benign Prostatic Hyperplasia. CURRENT BLADDER DYSFUNCTION REPORTS 2015; 10:186-192. [PMID: 25984251 PMCID: PMC4424373 DOI: 10.1007/s11884-015-0296-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Prostatic urethral lift (PUL) has been shown to be a safe, effective treatment option for lower urinary tract symptoms secondary to benign prostatic hyperplasia. Discomfort with PUL is similar to that with rigid cystoscopy and can be tolerated with local anesthesia in an office setting. Of those who are given voiding trials, 70-80 % of subjects do not require a catheter. Subjects often quickly return to pre-operative activity level with minimal absence from work. Symptom relief can start within 2 weeks and be sustained through 2 years. Urinary flow rate improvements have been shown to be durable through 2 years. The most common adverse effects are dysuria, hematuria, pain, and urgency which are typically mild to moderate and transient. Sexual function appears to be preserved after PUL with no reported new-onset erectile dysfunction or anejaculation events. The retreatment rate is reported to be 7.5 % at 2 years.
Collapse
Affiliation(s)
- Neal Shore
- Carolina Urologic Research Center, 823 82nd Parkway, Suite B, Myrtle Beach, SC 29572 USA
| |
Collapse
|
8
|
Update on Greenlight laser vaporization (PVP) 2014. World J Urol 2014; 33:531-7. [DOI: 10.1007/s00345-014-1437-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 10/31/2014] [Indexed: 10/24/2022] Open
|
9
|
A Prospective Study on the Effect of Photoselective Vaporization of Prostate by 120-W High-Performance System Laser on Sexual Function. J Endourol 2014; 28:1115-20. [DOI: 10.1089/end.2014.0170] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
10
|
Ishii T, Kambara Y, Yamanishi T, Naya Y, Igarashi T. Urine Flow Dynamics Through Prostatic Urethra With Tubular Organ Modeling Using Endoscopic Imagery. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2014; 2:1800709. [PMID: 27170869 PMCID: PMC4848057 DOI: 10.1109/jtehm.2014.2316148] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 11/18/2013] [Accepted: 03/15/2014] [Indexed: 11/17/2022]
Abstract
Voiding dysfunction is common in the aged male population. However, the obstruction mechanism in the lower urinary tract and critical points for obstruction remains uncertain. The aim of this paper was to develop a system to investigate the relationship between voiding dysfunction and alteration of the shape of the prostatic urethra by processing endoscopic video images of the urethra and analyzing the fluid dynamics of the urine stream. A panoramic image of the prostatic urethra was generated from cystourethroscopic video images. A virtual 3-D model of the urethra was constructed using the luminance values in the image. Fluid dynamics using the constructed model was then calculated assuming a static urethra and maximum urine flow rate. Cystourethroscopic videos from 11 patients with benign prostatic hyperplasia were recorded around administration of an alpha-1 adrenoceptor antagonist. The calculated pressure loss through the prostatic urethra in each model corresponded to the prostatic volume, and the improvements of the pressure loss after treatment correlated to the conventional clinical indices. As shown by the proposed method, the shape of the prostatic urethra affects the transporting urine fluid energy, and this paper implies a possible method for detecting critical lesions responsible for voiding dysfunction. The proposed method provides critical information about deformation of the prostatic urethra on voiding function. Detailed differences in the various types of relaxants for the lower urinary tract could be estimated.
Collapse
|
11
|
Patient-reported sexual outcomes after holmium laser enucleation of the prostate: a 3-year follow-up study. Urology 2014; 84:421-6. [PMID: 24958488 DOI: 10.1016/j.urology.2014.04.042] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/28/2014] [Accepted: 04/29/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the long-term patient reported sexual function outcomes of holmium laser enucleation of the prostate (HoLEP) for the treatment of lower urinary tract symptoms secondary to prostate enlargement. METHODS Three hundred ninety-three patients underwent a HoLEP between August 2007 and July 2013 and were reviewed in this retrospective analysis. Sexual function outcomes were assessed before HoLEP, and again at 3, 6, 12, 24, and 36 months after surgery using the International Index of Erectile Function 5 survey. International Prostate Symptom Scores (IPSS) were included for comparison and contextual functional outcome analysis. RESULTS At the time of surgery, the mean age was 70.9 years (52.0-89.0 years), mean body mass index was 27.7 kg/m(2) (18.0-48.0 kg/m(2)), and mean prostate volume was 96.7 g (20.1-375.0 g). Mean International Index of Erectile Function 5 scores at 3 (13.3 ± 8.37), 6 (12.1 ± 8.76), 12 (12.1 ± 8.83), 24 (12.6 ± 8.80), and 36 months (12.5 ± 8.45) showed no significant change from baseline. There was, however, a significant improvement from baseline seen in IPSS over the same time period (P = .0001). CONCLUSION These data confirm HoLEP has a significant impact on IPSS and no adverse impact on long-term patient reported sexual function. We believe this series represents the largest cohort with the longest follow-up to date. It represents an important tool for preoperative patient counseling for those patients considering surgical therapy for benign prostatic hyperplasia.
Collapse
|
12
|
Impact of Thulium VapoEnucleation of the Prostate on Erectile Function: A Prospective Analysis of 72 Patients at 12-Month Follow-up. Urology 2014; 83:175-80. [DOI: 10.1016/j.urology.2013.08.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 08/06/2013] [Accepted: 08/12/2013] [Indexed: 11/22/2022]
|
13
|
Kumar A, Vasudeva P, Kumar N, Nanda B, Jha SK, Mohanty N. A Prospective Randomized Comparative Study of Monopolar and Bipolar Transurethral Resection of the Prostate and Photoselective Vaporization of the Prostate in Patients Who Present with Benign Prostatic Obstruction: A Single Center Experience. J Endourol 2013; 27:1245-53. [DOI: 10.1089/end.2013.0216] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Anup Kumar
- Department of Urology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Pawan Vasudeva
- Department of Urology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Niraj Kumar
- Department of Urology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Biswajit Nanda
- Department of Urology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Sanjeev K. Jha
- Department of Urology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Nayhan Mohanty
- Department of Urology, VMMC and Safdarjung Hospital, New Delhi, India
| |
Collapse
|
14
|
Xie D, Chughtai B, Elterman DS, Seklehner S, Lee R, Te AE, Kaplan SA. The Link Between Benign Prostatic Hyperplasia and Sexual Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2013. [DOI: 10.1007/s11884-013-0187-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|