1
|
Manfredi C, García-Gómez B, Arcaniolo D, García-Rojo E, Crocerossa F, Autorino R, Gratzke C, De Sio M, Romero-Otero J. Impact of Surgery for Benign Prostatic Hyperplasia on Sexual Function: A Systematic Review and Meta-analysis of Erectile Function and Ejaculatory Function. Eur Urol Focus 2022; 8:1711-1732. [PMID: 35803852 DOI: 10.1016/j.euf.2022.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/17/2022] [Indexed: 01/25/2023]
Abstract
CONTEXT Several sexual side effects, including erectile, ejaculatory, and orgasmic dysfunction, were reported with the majority of surgical procedures for benign prostatic obstruction (BPO). OBJECTIVE To systematically review current evidence regarding the impact of benign prostatic hyperplasia (BPH) surgery on sexual function. EVIDENCE ACQUISITION A comprehensive bibliographic search on the MEDLINE, Cochrane Library, Embase, Web of Science, and Google Scholar databases was conducted in July 2021. The population, intervention, comparator, and outcome (PICO) model was used to define study eligibility. Studies were Included if they assessed patients with BPO and related lower urinary tract symptoms (P) undergoing BPH surgery (I) with or without a comparison between surgical treatments (C) evaluating the impact on sexual function (O). Retrospective and prospective primary studies were included. A pooled analysis was conducted on studies including the postoperative assessment of International Index of Erectile Function (IIEF)-5, Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD; Function and/or Bother), or retrograde ejaculation (RE) rate (PROSPERO database ID: CRD42020177907). EVIDENCE SYNTHESIS A total of 151 studies investigating 20 531 patients were included. Forty-eight randomized controlled trials evaluating 5045 individuals were eligible for the meta-analysis. In most studies (122, 80.8%), only erectile and/or ejaculatory function was evaluated. A substantial number of articles (67, 44.4%) also used nonvalidated tools to evaluate erectile and/or ejaculatory function. The pooled analysis showed no statistically significant changes in IIEF-5 score compared with baseline for the transurethral resection of the prostate (TURP; weighted mean difference [WMD] 0.76 pts; 95% confidence interval [CI] -0.1, 1.62; p = 0.08), laser procedure (WMD 0.33 pts; 95% CI -0.1, 0.77; p = 0.13), and minimally invasive treatment (WMD -1.37 pts; 95% CI -3.19, 0.44; p = 0.14) groups. A statistically significantly higher rate of RE was found after TURP (risk ratio [RR] 13.31; 95% CI 8.37, 21.17; p < 0.00001), other electrosurgical procedures (RR 34.77; 95% CI 10.58, 127.82; p < 0.00001), and the entire laser group (RR 17.37; 95% CI 5.93, 50.81; p < 0.00001). No statistically significant increase in RE rate was described after most of the minimally invasive procedures (p > 0.05). The pooled analysis of MSHQ-EjD scores was possible only for prostatic urethral lift, showing no statistically significant difference between baseline and post-treatment MSHQ-EjD Function scores (WMD -0.80 pts; 95% CI -2.41, 0.81; p = 0.33), but postoperative MSHQ-EjD Bother scores were significantly higher (WMD 0.76 pts; 95% CI 0.22, 1.30; p = 0.006). CONCLUSIONS Erectile function appears to be unaffected by most surgical procedures for BPO. RE is a very common adverse event of BPH surgery, although emerging minimally invasive surgical procedures could be associated with a lower risk. PATIENT SUMMARY Benign prostatic hyperplasia surgery can have an impact on sexual function, mainly involving ejaculatory function.
Collapse
Affiliation(s)
- Celeste Manfredi
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Borja García-Gómez
- Department of Urology, Hospital Universitario 12 Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain; ROC Clinic, Madrid, Spain
| | - Davide Arcaniolo
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Esther García-Rojo
- Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain; ROC Clinic, Madrid, Spain
| | - Fabio Crocerossa
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Riccardo Autorino
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | - Christian Gratzke
- Department of Urology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Marco De Sio
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Javier Romero-Otero
- Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain; ROC Clinic, Madrid, Spain.
| |
Collapse
|
2
|
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
|
3
|
Soans J, Vazirian-Zadeh M, Kum F, Dhariwal R, Breish MO, Singh S, Mahmalji W, Katmawi-Sabbagh S. Can surgical treatment for benign prostatic hyperplasia improve sexual function? A systematic review. Aging Male 2020; 23:770-779. [PMID: 30955407 DOI: 10.1080/13685538.2019.1593356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Erectile dysfunction is an established, well known risk of any operative management of benign prostatic hyperplasia (BPH). However, there are some cases reported in which surgical treatment has paradoxically improved erectile function. Here, we present a systematic review of the literature pertaining to the effect of surgery on sexual function, focusing on reports of improvement in erectile function following surgery. MATERIALS AND METHODS We searched PUBMED, EMBASE, Web of Knowledge, and SCOPUS databases for the following keywords: (("sexual function" OR "erectile function") AND "improvement" AND "benign prostatic hyperplasia" AND "surgery"). RESULTS Sixteen studies (total n = 2087) were reviewed which reported a significant improvement in any aspect of erectile function. Ten of these studies had a follow-up period of 12 months or more while five had a follow up less than 12 months. Various surgical methods were included in the 16 studies; however, five reported TURP outcomes specifically. Eleven studies reported outcomes using the International Index of Erectile Function (IIEF). Overall, a further 87 studies showed no significant change and 8 studies showed a significant reduction. CONCLUSIONS The majority of studies report no change in erectile function following surgical intervention for BPH. There seems to be no obvious correlating factor between the studies reporting an improvement in erectile function. Further research is needed to guide us in how to consent our patients for erectile function outcomes for BPH surgery.
Collapse
Affiliation(s)
- Julian Soans
- St George's University Medical School, London, UK
| | | | - Francesca Kum
- Department of Urology, St George's Hospital, London, UK
| | | | | | - Sohail Singh
- King's College London School of Medicine, London, UK
| | - Wasim Mahmalji
- Department of Urology, Hereford County Hospital, Herford, UK
| | | |
Collapse
|
4
|
Wu B, Li J, Xu Q, Hou R, Jia W, Chen Q. Vaporization of Prostate by 160W GreenLight Laser on Postoperative Erectile Function. Urology 2019; 132:164-169. [DOI: 10.1016/j.urology.2019.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/21/2019] [Accepted: 06/26/2019] [Indexed: 11/30/2022]
|
5
|
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]
|
6
|
Park J, Cho SY, Cho MC, Jeong H, Son H. Changes in Erectile Function after Photoselective Vaporization of the Prostate with a 120-W GreenLight High-Performance System Laser: 2-Year Follow-Up. World J Mens Health 2017; 35:156-162. [PMID: 29164830 PMCID: PMC5746486 DOI: 10.5534/wjmh.17027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/11/2017] [Accepted: 09/13/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose To evaluate the impact of photoselective vaporization of the prostate (PVP) with a 120-W GreenLight high-performance system on erectile function in a 2-year follow-up study. Materials and Methods One hundred seventy-seven patients who underwent PVP during 2008 to 2012 were analyzed retrospectively. The patients were divided into 5 groups according to their preoperative 5-item International Index of Erectile Function (IIEF-5) scores: Group I (IIEF-5: 5~7, n=28), II (IIEF-5: 8~11, n=47), III (IIEF-5: 12~16, n=43), IV (IIEF-5: 17~21, n=34), and V (IIEF-5: 22~25, n=25). The patients were assessed before surgery and 6, 12, and 24 months after the PVP. Their International Prostate Symptom Score/quality of life, maximum urinary flow rate/post-void residual urine volume, and IIEF-5 scores were measured at each visit. Results The mean age and presence of hypertension were significantly different among the 5 groups. Perioperative parameters and postoperative complication rates showed no statistical differences. After PVP, voiding parameters were significantly improved in all the groups and sustained during the 2-year follow-up. The postoperative IIEF-5 scores fell slightly overall, while group V showed the largest significant deterioration. In multivariate analysis, body mass index (BMI) was the only independent predictor of decreased erectile function after PVP. Conclusions Erectile function declined in all the groups after PVP, with the most extensive deterioration observed in patients with normal erectile function preoperatively. Preoperative BMI was the only independent risk factor for a meaningful decrease in erectile function after PVP.
Collapse
Affiliation(s)
- Juhyun Park
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Yong Cho
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Min Chul Cho
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Jeong
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hwancheol Son
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
| |
Collapse
|
7
|
Longitudinal changes in erectile function after thulium:YAG prostatectomy for the treatment of benign prostatic obstruction: a 1-year follow-up study. Lasers Med Sci 2017; 32:1517-1523. [PMID: 28685201 DOI: 10.1007/s10103-017-2273-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 06/20/2017] [Indexed: 10/19/2022]
Abstract
This study aimed to evaluate the impact of thulium:yttrium-aluminum-garnet (Tm:YAG) (RevoLix®) laser prostatectomy for the treatment of benign prostatic obstructions on erectile function (EF). A total of 208 patients who underwent Tm:YAG laser prostatectomies participated in this study. All cases were evaluated preoperatively and at 3, 6, and 12 months postoperatively using the International Prostate Symptom Score (IPSS), quality of life (QoL) score, and the International Index of Erectile Function (IIEF-5) questionnaires. Patients were divided into groups A (severe erectile dysfunction [ED]), B (moderate ED), and C (mild-to-normal ED), according to their IIEF-5 scores. The median patient ages were 69, 65, and 62 years in groups A, B, and C, respectively. Significant improvements occurred in the IPSS and QoL score within the groups during the 12-month follow-up period. The IIEF-5 scores at 3 months postoperatively were lower than the preoperative scores in groups B and C. The IIEF-5 scores subsequently improved during the 12-month follow-up period. The slope of the relationship between the IIEF-5 score and the time since Tm:YAG laser prostatectomy had a ß value of 0.2210 (95% confidence interval 0.103 to 0.338, p = 0.0003); hence, each postoperative month was associated with an increase of 0.2210 in the IIEF-5 score. The IIEF-5 scores gradually increased and reached the preoperative levels by the 12-month follow-up assessment. Although the IIEF-5 score dropped significantly during the first 3 months postoperatively, it improved over the following 12 months. Tm:YAG laser prostatectomy did not impact on EF ultimately.
Collapse
|
8
|
Ouyang Y, Liu C, Guan W, Zhao Y, Xu Y, Wu Y. Impact of 160 W Greenlight laser vaporization of the prostate on erectile function: a prospective randomized controlled trial with 1-year follow-up. Photomed Laser Surg 2016; 32:463-7. [PMID: 25101536 DOI: 10.1089/pho.2014.3727] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Our aim was to evaluate the impact of 160 W Greenlight laser vaporization of the prostate on erectile function by the International Index of Erectile Function (IIEF-5) in 1-year follow-up in patients with lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH). BACKGROUND DATA Although high-power Greenlight laser has greatly improved the efficiency of vaporization of the prostate, the impact of it on erectile function remains uncertain. MATERIALS AND METHODS A total of 80 BPH patients with normal erectile function or mild erectile dysfunction (IIEF-5 ≥12) were included in this study. They were randomly assigned to two equal groups: 80 or 160 W. Both groups were compared regarding all relevant preoperative, operative, and postoperative parameters. Urinary function in terms of International Prostate Symptom Score (IPSS), quality of life (QOL) score, maximum flow rate (Qmax), and residual urinary volume (RUV) were evaluated at 1, 3, 6, and 12 months postoperatively. Erectile function was evaluated by IIEF-5 at 3, 6, and 12 months postoperatively. RESULTS Baseline characteristics of the two groups were comparable. Mean operative time was significantly shorter for the 160 W group. Urinary function in terms of IPSS, QOL, Qmax, and RUV were all significantly improved over baseline in both groups. There were no significant differences in these urinary functional parameters between the two groups at any point of follow-up. IIEF-5 scores of both groups significantly decreased at 3 months postoperatively compared with baseline, but at 6 and 12 months postoperatively, IIEF-5 score of either group increased to baseline, and was not different from baseline. At any point of follow-up, IIEF-5 scores of the two groups were comparable. CONCLUSIONS Greenlight laser (160 W) vaporization of the prostate will not increase the risk of impairing erectile function.
Collapse
Affiliation(s)
- Yun Ouyang
- Department of Urology, Navy General Hospital of the Chinese People's Liberation Army , Haidian District, Beijing, China
| | | | | | | | | | | |
Collapse
|
9
|
Li Z, Chen P, Wang J, Mao Q, Xiang H, Wang X, Wang X, Zhang X. The impact of surgical treatments for lower urinary tract symptoms/benign prostatic hyperplasia on male erectile function: A systematic review and network meta-analysis. Medicine (Baltimore) 2016; 95:e3862. [PMID: 27310968 PMCID: PMC4998454 DOI: 10.1097/md.0000000000003862] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) is common in adult men and can impair erectile function (EF). It was believed surgical treatments for this illness can improve EF due to the relief of LUTS while they were also reported harmed EF as heating or injury effect. Current network meta-analysis aimed to elucidate this discrepancy.Randomized controlled trials (RCTs) were identified. Direct comparisons were conducted by STATA and network meta-analysis was conducted by Generate Mixed Treatment Comparison. Random-effects models were used to calculate pooled standard mean difference and 95% confidence intervals and to incorporate variation between studies.Eighteen RCTs with 2433 participants were analyzed. Nine approaches were studied as transurethral resection of the prostate (TURP), plasmakinetic resection of the prostate (PKRP), plasmakinetic enucleation of the prostate (PKEP), Holmium laser enucleation of the prostate (HoLEP), Holmium laser resection of the prostate (HoLRP), photoselective vaporization of the prostate (PVP), Thulium laser, open prostatectomy (OP), and laparoscopic simple prostatectomy (LSP). In direct comparisons, all surgical treatments did not decrease postoperative International Index of Erectile Function (IIEF)-5 score except PVP. Moreover, patients who underwent HoLEP, PKEP, Thulium laser, and TURP had their postoperative EF significantly increased. Network analysis including direct and indirect comparisons ranked LSP at the highest position on the variation of postoperative IIEF-5 score, followed by PKRP, HoLEP, TURP, Thulium laser, PKEP, PVP, HoLRP, and OP. In subgroup analysis, only PVP was found lower postoperative EF in the short term and decreased baseline group, whereas TURP increased postoperative IIEF-5 score only for patients with normal baseline EF. However, HoLEP and PKEP showed pro-erectile effect even for patients with decreased baseline EF and short-term follow-up. Our novel data demonstrating surgical treatments for LUTS/BPH showed no negative impact on postoperative EF except PVP. Moreover, HoLEP and PKEP were found pro-erectile effect for all subgroups. New technologies, such as LSP, PKRP, and Thulium laser, were ranked at top positions in the network analysis, although they had no pro-erectile effect in direct comparison due to limited original studies or poor baseline EF. Therefore, further studies and longer follow-up are required to substantiate our findings.
Collapse
Affiliation(s)
- Zhuo Li
- Department of Urology, Zhongnan Hospital of Wuhan University
| | - Ping Chen
- Department of Urology, Zhongnan Hospital of Wuhan University
| | - Jun Wang
- Department of Urology, Children's Hospital of Wuhan
| | - Qi Mao
- Department of Urology, Zhongnan Hospital of Wuhan University
| | - Han Xiang
- Department of Urology, Zhongnan Hospital of Wuhan University
| | - Xiao Wang
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, P.R. China
| | - Xinghuan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University
| | - Xinhua Zhang
- Department of Urology, Zhongnan Hospital of Wuhan University
| |
Collapse
|
10
|
Becher EF, McVary KT. Surgical Procedures for BPH/LUTS: Impact on Male Sexual Health. Sex Med Rev 2015; 2:47-55. [PMID: 27784543 DOI: 10.1002/smrj.20] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Lower urinary tract symptoms (LUTS) because of benign prostatic hyperplasia (BPH) are a highly prevalent condition in men over 50 years old, and their incidence increases with age. The relationship between LUTS and erectile dysfunction (ED) has received increased attention recently because both diseases are highly prevalent, frequently co-associated in the same aging male group, and contribute significantly to the overall quality of life. In this review, we will examine the literature to assess the impact of surgical and minimally invasive treatments for LUTS/BPH on the male's sexual health. METHODS The impact of the various surgical and minimally invasive treatments for LUTS/BPH was reviewed to ascertain the impact on erectile and ejaculatory function. RESULTS Sexual side effects of treatment for LUTS/BPH are underappreciated by urologists but likely play a prominent role in patient decision making, creating a disparity between provider and patient. Almost all accepted therapies for LUTS (surgical or medical) can affect some aspect of sexual health, making it imperative that health-care professionals understand their patients' concerns and motivations in these two linked diseases. The incidence of newly diagnosed postoperative ED in patients treated with monopolar transurethral resection (TURP) is around 14%, with reported values in various studies ranging from 0-32.5%, 7.7%, 6.5%, 17%, to 14%. Importantly, there is no significant difference reported between bipolar and monopolar TURP on sexual function. CONCLUSION The risk of sexual side effects is an important one to consider in discussing the implications for any LUTS intervention as they play a prominent role in patient motivation, acceptance of bother and decision making concerning surgical intervention, thus creating a potential disparity between provider and patient. Becher EF and McVary KT. Surgical procedures for BPH/LUTS: Impact on male sexual health. Sex Med Rev 2014;2:47-55.
Collapse
Affiliation(s)
- Edgardo F Becher
- Division of Urology, Hospital de Clínicas "José de San Martín", University of Buenos Aires, Buenos Aires, Argentina.
| | - Kevin T McVary
- School of Medicine, Southern Illinois University Springfield, Springfield, IL, USA
| |
Collapse
|
11
|
Telli O, Okutucu TM, Suer E, Burgu B, Gulpinar O, Yaman O, Bozkurt S. A prospective, randomized comparative study of monopolar transurethral resection of the prostate versus photoselective vaporization of the prostate with GreenLight 120-W laser, in prostates less than 80 cc. Ther Adv Urol 2015; 7:3-8. [PMID: 25642290 DOI: 10.1177/1756287214556643] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE In this study we aimed to compare photoselective vaporization (PVP) with the GreenLight 120-W Laser and monopolar transurethral resection as surgical treatments of prostates less than 80 cc in men with obstructive benign prostatic hyperplasia. METHODS From February 2009 to March 2012 we allocated 101 patients with a prostate glands of less than 80 cc; patients were randomly assigned for surgical treatment with monopolar transurethral resection of the prostate (TURP) (n = 62) or PVP (n = 39). Serum prostate specific antigen (PSA), International Prostate Symptom Score (IPSS), Sexual Health Inventory for Men (SHIM), maximum flow rate (Qmax) postmicturition residual (PMR), transrectal ultrasound volumes (TRUS), postvoid urine residual (PVR), complications, re-operations and hospitalization time were collected. The patients were seen in the follow up at 6, 12 and 24 months. RESULTS Median age was 69 (56-87) years old in the TURP group and 67 (51-87) years old in the PVP group. Mean preoperative prostate volume was 55 cc (40-72) and 60 cc (41-75) cc in the TURP group versus the PVP group. There was no statistically difference in subjectively (IPSS, SHIM) and objectively (Qmax-PMR) parameters and postoperatively complication rates between the two groups (p > 0.05). A significant difference was observed in the PVP group with a 2 (1-4) days hospital stay compared with 5 (3-9) days for the TURP group (p < 0.001). CONCLUSION Prostate PVP and TURP are effective surgical treatments for benign prostatic hyperplasia. Postoperative functional improvements were durable and equivalent in the two groups. The two techniques have a similar complication rate.
Collapse
Affiliation(s)
- Onur Telli
- Department of Urology, Ankara University School of Medicine, Sihhiye, Ankara, Turkey
| | | | - Evren Suer
- Department of Urology, School of Medicine, Ankara University, Ankara, Turkey
| | - Berk Burgu
- Department of Urology, School of Medicine, Ankara University, Ankara, Turkey
| | - Omer Gulpinar
- Department of Urology, School of Medicine, Ankara University, Ankara, Turkey
| | - Onder Yaman
- Department of Urology, School of Medicine, Ankara University, Ankara, Turkey
| | - Selen Bozkurt
- Department of Biostatistics and Medical Informatics, School of Medicine, Akdeniz University, Antalya, Turkey
| |
Collapse
|
12
|
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
|
13
|
Wang Y, Shao J, Lu Y, Lü Y, Li X. Impact of 120-W 2-μm continuous wave laser vapoenucleation of the prostate on sexual function. Lasers Med Sci 2013; 29:689-93. [DOI: 10.1007/s10103-013-1386-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 06/26/2013] [Indexed: 10/26/2022]
|
14
|
Guo Z, Jin X. The volume of prostate can impact the male sexual function following photoselective vaporization of the prostate: results of a prospective analysis of 128 patients with 2-year follow-up. Int Urol Nephrol 2013; 45:961-6. [PMID: 23779228 DOI: 10.1007/s11255-013-0489-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 06/05/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the impact of the male sexual function following photoselective vaporization of the prostate treatment in different volume of prostates. METHODS One hundred and twenty-eight consecutive patients with active sexual ability who underwent prostate vaporization with the green light laser during 2009-2011 were enrolled. We divided all patients into two groups group I (<70 ml, n = 58) and group II (≥ 70 ml, n = 70) according to the volume of prostate. Two group patients were assessed by International Index of Erectile Function (IIEF-5) preoperatively and at 1, 3, 6, 12, and 24 months. We measured the IPSS, QoL, Q max, PRV PSA at the baseline, postoperation and every visit. IIF-5 questionnaires were also collected in every visit. RESULT One hundred and twenty-eight patients were under successful operations. In the 1, 3, 6, 12 and 24 months, main parameters following operation such as Q max PRV IPSS and QoL scores had significant improved compared to baseline. However, the group II was better than group I in every visits. As the 6, 12 and 24 months of questionnaires, group II had less IIEF scores than group I. To evaluate the adverse sexual outcomes of IIEF-5 lists, the erectile dysfunction and overall unsatisfied scores of group II were much more than group I in 6-24-month visits. CONCLUSION The larger volume of prostate (≥ 70 ml) following PVP treatment has negative influence on sexual function in the long term (more than 6 months). The adverse sexual outcomes were significant increased after PVP in the prostate with more than 70-ml volume.
Collapse
Affiliation(s)
- Zhen Guo
- Minimally Invasive Urology Center, Provincial Hospital, Affiliated to Shandong University, No, 324 Jingwu Road, Jinan, 250021, China.
| | | |
Collapse
|
15
|
Osterberg EC, Choi BB. Review of current laser therapies for the treatment of benign prostatic hyperplasia. Korean J Urol 2013; 54:351-8. [PMID: 23789041 PMCID: PMC3685632 DOI: 10.4111/kju.2013.54.6.351] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 05/20/2013] [Indexed: 12/11/2022] Open
Abstract
The gold standard for symptomatic relief of bladder outlet obstruction secondary to benign prostatic hyperplasia has traditionally been a transurethral resection of the prostate (TURP). Over the past decade, however, novel laser technologies that rival the conventional TURP have multiplied. As part of the ongoing quest to minimize complications, shorten hospitalization, improve resection time, and most importantly reduce mortality, laser prostatectomy has continually evolved. Today, there are more variations of laser prostatectomy, each with several differing surgical techniques. Although abundant data are available confirming the safety and feasibility of the various laser systems, future randomized-controlled trials will be necessary to verify which technique is superior. In this review, we describe the most common modalities used to perform a laser prostatectomy, mainly, the holmium laser and the potassium-titanyl-phosphate lasers. We also highlight the physical and clinical characteristics of each technology with a review of the most current and highest-quality literature.
Collapse
|
16
|
Bell JR, Laborde E. Update on the sexual impact of treatment for benign prostatic hyperplasia. Curr Urol Rep 2013; 13:433-40. [PMID: 23065462 DOI: 10.1007/s11934-012-0278-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There is an established link between lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) and erectile dysfunction (ED). The medical and surgical management of LUTS can affect erectile function (EF), cause ejaculatory dysfunction (EjD) or affect libido. This article will review the effects of these therapies on sexual function.
Collapse
Affiliation(s)
- John Roger Bell
- Department of Urology, Ochsner Clinic Foundation, New Orleans, LA 70121, USA.
| | | |
Collapse
|
17
|
Terrasa J, Cornu J, Haab F, Cussenot O, Lukacs B. Prospective, Multidimensional Evaluation of Sexual Disorders in Men after Laser Photovaporization of the Prostate. J Sex Med 2013; 10:1363-71. [DOI: 10.1111/jsm.12044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
18
|
Traitement de l’hyperplasie bénigne de prostate par photovaporisation au laser Greenlight® : analyse de la littérature. Prog Urol 2013; 23:77-87. [DOI: 10.1016/j.purol.2012.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 10/18/2012] [Accepted: 10/21/2012] [Indexed: 01/09/2023]
|
19
|
Kumar A, Vasudeva P, Kumar N, Nanda B, Mohanty NK. Evaluation of the Effect of Photoselective Vaporization of the Prostate on Sexual Function in a Prospective Study: A Single Center Experience of 150 Patients. J Endourol 2012:150127063131006. [PMID: 22849319 DOI: 10.1089/end.2012.0376] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract Background and Purpose: Photoselective vaporization of the prostate (PVP) has emerged as a minimally invasive alternative to transurethral resection of the prostate for treatment of benign prostate hyperplasia (BPH) with lower urinary tract symptoms (LUTS). Very few prospective studies have addressed the effect of PVP on sexual function. We performed this prospective study to assess the short-term effect of PVP on erectile function in patients who present with LUTS secondary to BPH. Patients and Methods: There were 150 consecutive patients who presented with LUTS secondary to BPH who underwent PVP and who were enrolled prospectively in this study. Patients were categorized in two groups: Group A, International Index of Erectile Function (IIEF) ≥19; group B, IIEF <19. PVP was performed by using an 80 W GreenLight laser. Patients preoperative, perioperative, and follow-up data were recorded. Erectile function was assessed preoperatively and postoperatively at 1, 3, 6, and 12 months using IIEF-5. In follow-up, Ultrasonography of the kidneys, ureters, and bladder for residual prostate and postvoid residual urine, uroflowmetry, kidney function tests, and urine culture were performed at each visit. Cystoscopy was performed at 3 months. Data were analyzed statistically. Results: The two patient groups were comparable in their preoperative and perioperative data. Both groups showed improvement in International Prostate Symptom Score, maximum flow rate, quality of life, and decrease in postvoid residual urine at 1, 3, 6, and 12 months with no statistical significance. IIEF-5 scores in Group A, however, were 21.1, 19.2, 17.1, 16.2, and 16.1, respectively, at preoperative, postoperative month 1, 3, 6, and 12, respectively (P=0.02). IIEF-5 scores in Group B were 13.2, 12.1, 11.3, 11.2, and 10.9, respectively, at preoperative, postoperative month 1, 3, 6, and 12, respectively (P=0.45). Conclusions: In patients with normal preoperative erectile function, PVP resulted in significant decrease in EF up to follow-up of 1 year. In patients with preoperative ED, however, PVP did not significantly decrease EF.
Collapse
Affiliation(s)
- Anup Kumar
- Department of Urology, Vardhman Mahaveer Medical College and Safadrjang Hospital , New Delhi, India
| | | | | | | | | |
Collapse
|
20
|
Jeong MS, Ha SB, Lee CJ, Cho MC, Kim SW, Paick JS. Serial Changes in Sexual Function Following Holmium Laser Enucleation of the Prostate: A Short-term Follow-up Study. Korean J Urol 2012; 53:104-8. [PMID: 22379589 PMCID: PMC3285704 DOI: 10.4111/kju.2012.53.2.104] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 10/24/2011] [Indexed: 12/03/2022] Open
Abstract
Purpose To evaluate the serial changes in sexual function in the short-term period after holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia (BPH) and to investigate whether a change in each domain of the International Index of Erectile Function (IIEF) is associated with improvement of micturition. Materials and Methods Thirty-eight potent men who underwent HoLEP and in whom complete 12-month follow-up data on the IIEF were available were included in this retrospective study. All patients underwent a baseline evaluation for BPH. The surgical outcome was evaluated at 1, 3, 6, and 12 months postoperatively by use of the International Prostate Symptom Score, IIEF, and uroflowmetry. Results The mean age and body mass index of the patients was 64.5±6.2 years and 24.2±2.6 kg/m2, respectively. Mean total prostate volume and transitional zone volume were 48.8±18.8 ml and 24.2±16.1 ml, respectively. Most IIEF domain scores showed a slight decrease at 1, 3, and 6 months after surgery but recovered to the baseline or showed a marginal but nonsignificant increase at 12 months postoperatively compared with baseline. Orgasmic function and the overall sexual satisfaction domain score remained slightly reduced up to 12 months postoperatively. There was no significant correlation between improvement of micturition and change in sexual function throughout the follow-up period after surgery. Conclusions Although HoLEP achieves significant improvements in micturition, overall sexual function decreases slightly in the early postoperative period, but recovers to the baseline at 12 months postoperatively. Our data suggest that changes in sexual function after HoLEP are not associated with improvement of micturition.
Collapse
Affiliation(s)
- Min Su Jeong
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | | | | |
Collapse
|
21
|
Yee CLS, Pal RP, Batchelder A, Khan MA. Risk of erectile dysfunction and retrograde ejaculation associated with thulium laser vaporesection of the prostate for bladder outflow obstruction: a retrospective study. Urol Int 2012; 88:165-9. [PMID: 22237486 DOI: 10.1159/000333046] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 09/09/2011] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study was to determine the incidence of erectile dysfunction and retrograde ejaculation following thulium:yttrium-aluminium-garnet (Tm:YAG) laser prostate vaporesection (ThuVaRP). PATIENTS AND METHODS Between January 2009 and June 2010, 113 consecutive patients underwent ThuVaRP for bladder outflow obstruction. Of these, 54 (48%) were included in the study as they were able to maintain an erection for sexual intercourse prior to undergoing ThuVaRP. All patients had benign pathology and had not undergone previous bladder neck surgery. The incidence of erectile dysfunction and retrograde ejaculation was reported at a mean follow-up period of 12 months post-operatively. RESULTS The mean patient age was 71 years (range 46-90). The mean follow-up period was 12 months (range 4-21). 11 (20%) patients experienced worsening erectile function with 3 (6%) noticing an improvement. A total of 30 patients (56%) experienced some degree of retrograde ejaculation. 4 patients (7%) noticed an improvement in their ejaculation. Retrograde ejaculation was more common in patients with an indwelling catheter in situ for refractory urinary retention (43 vs. 17%, p = 0.04) and in diabetic patients (27 vs. 4%, p = 0.03). There was an increased trend of erectile dysfunction in men aged ≥70 years, with hypertension and with hypercholesterolaemia, but this was not significant. CONCLUSION Our retrospective study has demonstrated that the overall risk of erectile dysfunction and retrograde ejaculation associated with ThuVaRP is 20 and 56%, respectively.
Collapse
Affiliation(s)
- Carol Ling Sze Yee
- Department of Urology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | | | | | | |
Collapse
|
22
|
The relationship between photoselective vaporization of the prostate and sexual function. Curr Urol Rep 2011; 12:261-4. [PMID: 21656206 DOI: 10.1007/s11934-011-0199-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Although transurethral resection of the prostate remains the gold standard treatment of lower urinary tract symptoms that are refractory to medical therapy, photovaporization of the prostate (PVP) has become a popular alternative. Early PVP studies have been encouraging, but insufficient data exist regarding the effects of PVP on long-term sexual function. This article analyzes the published data and briefly reviews the literature. The studies on PVP are heterogeneous, and other than one that showed a decreased International Index of Erectile Function score after PVP, all the studies analyzed the population at large and did not focus on preoperatively potent patients. Further well-conducted and prospective studies are needed to confirm the impact of PVP on erectile function.
Collapse
|
23
|
Metcalfe C, Poon KS. Long-term results of surgical techniques and procedures in men with benign prostatic hyperplasia. Curr Urol Rep 2011; 12:265-73. [PMID: 21484456 DOI: 10.1007/s11934-011-0193-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Benign prostatic hyperplasia (BPH) is one of the most common conditions associated with the aging male. Surgical management of lower urinary tract symptoms attributed to BPH has progressed over time as urologic surgeons search for more innovative and less invasive forms of treatment. Transurethral resection of the prostate (TURP) has long been the "gold standard" to which all other forms of treatment are compared. There are several different methods of surgical treatment of BPH, including whole gland enucleation/intact removal, vaporization, and induction of necrosis with delayed reabsorption as well as hybrid techniques. As with any form of surgical intervention, long-term results define success. Long-term follow-up consists of examining overall efficacy with attention to associated adverse events. TURP has the luxury of the longest follow-up, while less invasive forms of treatment starting to acquire long-term data. There are several surgical options for BPH; newer methods do show promise, while the "gold standard" continues to demonstrate excellent surgical results.
Collapse
Affiliation(s)
- Charles Metcalfe
- Department of Urologic Sciences, University of British Columbia, Richmond, BC, Canada
| | | |
Collapse
|
24
|
Orabi H, Albersen M, Lue TF. Association of lower urinary tract symptoms and erectile dysfunction: pathophysiological aspects and implications for clinical management. Int J Impot Res 2011; 23:99-108. [PMID: 21593760 DOI: 10.1038/ijir.2011.14] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
25
|
Elmansy HM, Elzayat E, Elhilali MM. Holmium Laser Ablation Versus Photoselective Vaporization of Prostate Less Than 60 cc: Long-Term Results of a Randomized Trial. J Urol 2010; 184:2023-8. [DOI: 10.1016/j.juro.2010.06.107] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Indexed: 10/19/2022]
Affiliation(s)
- Hazem M. Elmansy
- Division of Urology, Department of Surgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Ehab Elzayat
- Division of Urology, Department of Surgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Mostafa M. Elhilali
- Division of Urology, Department of Surgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
26
|
Ku JH, Kim SW, Paick JS. Impact of prostate volume on the efficacy of high-power potassium-titanyl-phosphate photoselective vaporization of the prostate: a retrospective, short-term follow-up study on evaluating feasibility and safety. Yonsei Med J 2010; 51:877-82. [PMID: 20879054 PMCID: PMC2995958 DOI: 10.3349/ymj.2010.51.6.877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE We determined the impact of prostate volume on the efficacy of the high-power (80 W) potassium-titanyl-phosphate (KTP) photoselective laser vaporization of the prostate in men with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS Patients were stratified into 3 groups according to prostate volume: '< 40 g' (n = 49) and '40-59 g' (n = 49) and '≥ 60 g' (n = 22). Median follow-up was 9 months (range 6 to 21). RESULTS No differences in age and follow-up duration were observed in the three groups. At baseline, no significant differences were noted in the three groups in terms of the International Prostate Symptom Score (IPSS) (21.4, 19.4 and 19.1; p = 0.412) as well as the maximum flow rate (Qmax) (10.2, 9.2, and 8.6 mL/s; p = 0.291) and post-void residual (PVR) (66.2, 80.4, and 71.5 mL; p = 0.856). The mean operative times were 30.9, 46.9, and 58.6 minutes (p< 0.001) and total median energy deliveries for each group were 62.3, 97.6, and 135.9 kJ, respectively (p< 0.001). No severe intraoperative complication was observed. At the last follow-up, these parameters improved significantly regardless of prostate volume, and the IPSS (11.1, 9.4, and 12.3; p = 0.286) as well as Qmax (15.9, 15.9, and 14.2 mL/s; p = 0.690) and PVR (33.7, 28.4, and 14.2 mL; p = 0.395) were not significantly different among the groups. CONCLUSION Although a larger prostate requires more time and energy delivery, photoselective laser vaporization of the prostate is safe and efficacious for patients with LUTS regardless of prostate volume.
Collapse
Affiliation(s)
- Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Soo Woong Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Seung Paick
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
27
|
Spaliviero M, Strom KH, Gu X, Araki M, Culkin DJ, Wong C. Does Greenlight HPS(™) laser photoselective vaporization prostatectomy affect sexual function? J Endourol 2010; 24:2051-7. [PMID: 20964486 DOI: 10.1089/end.2010.0296] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE We evaluate the impact of GreenLight High-Performance System (HPS™) laser photoselective vaporization prostatectomy (PVP) on sexual function after treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). PATIENTS AND METHODS We prospectively evaluated our initial single surgeon experience with GreenLight HPS™ laser PVP. All patients had American Urological Association Symptom Score (AUASS), Sexual Health Inventory for Men (SHIM), maximum flow rate (Qmax), and postvoid residual (PVR) determinations. Transurethral PVP was performed using a 120W GreenLight HPS™ side-firing laser system. AUASS, SHIM, Qmax, and PVR were evaluated 1, 4, 12, 24, and 52 weeks postsurgery. Wilcoxon signed rank test and the Student t-test were used to assess the changes from baseline. RESULTS Seventy-two patients completed 52 weeks of follow-up, having a median age of 69 (45-89) years. The median prostate volume was 62 (21-263) mL. Median AUASS improved significantly from 23 to 8, 6, 5, 5, and 4 (P < 0.05) at 1, 4, 12, 24, and 52 weeks, respectively. Median SHIM changed from 15 to 12, 16, 19, 16, and 17 during the follow-up period (P = 0.032, 0.427, 0.074, 0.081, and 0.259). Minimum change (0 ± 5) in SHIM occurred in 85.5%, 90.5%, 78.8%, 77.5%, and 73.7% of patients; 11.3%, 6.3%, 6.0%, 4.8%, and 7.0% of patients had deterioration of erectile function (SHIM reduction >5); and 3.2%, 3.2%, 15.2%, 17.7%, and 19.3% of patients had improvement of erectile function (SHIM increase >5). Incidence of new-onset retrograde ejaculation was 30%. CONCLUSION GreenLight HPS™ laser PVP appears to not have a detrimental effect on erectile function.
Collapse
Affiliation(s)
- Massimiliano Spaliviero
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA
| | | | | | | | | | | |
Collapse
|
28
|
Bruyère F, Puichaud A, Pereira H, Faivre d'Arcier B, Rouanet A, Floc'h AP, Bodin T, Brichart N. Influence of Photoselective Vaporization of the Prostate on Sexual Function: Results of a Prospective Analysis of 149 Patients with Long-Term Follow-Up. Eur Urol 2010; 58:207-11. [DOI: 10.1016/j.eururo.2010.04.027] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Accepted: 04/26/2010] [Indexed: 10/19/2022]
|
29
|
Reich O. What Do We Know (or Think We Know) About Erectile Dysfunction Following Laser Treatments for Lower Urinary Tract Symptoms? Eur Urol 2010; 58:212-3. [DOI: 10.1016/j.eururo.2010.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 05/06/2010] [Indexed: 11/26/2022]
|
30
|
Sexual Outcome Following Photoselective Vaporization of the Prostate: Is There Enough Evidence? Eur Urol 2010; 58:214-5. [DOI: 10.1016/j.eururo.2010.05.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 05/18/2010] [Indexed: 11/22/2022]
|
31
|
Wiser HJ, Köhler TS. Sexual impact of treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia. Curr Urol Rep 2010; 11:228-35. [PMID: 20467845 DOI: 10.1007/s11934-010-0112-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) and the treatment of these conditions are commonly associated with sexual dysfunction. The effects on sexual function of common medical and surgical therapies used in the treatment of LUTS/BPH are reviewed. Also discussed is the emerging use of phosphodiesterase inhibitors in the treatment of LUTS/BPH.
Collapse
Affiliation(s)
- Herbert J Wiser
- Division of Urology, Southern Illinois University School of Medicine, 301 North 8th Street, Suite 4B, PO Box 19665, Springfield, IL 62794, USA
| | | |
Collapse
|
32
|
Rieken M, Ebinger Mundorff N, Bonkat G, Wyler S, Bachmann A. Complications of laser prostatectomy: a review of recent data. World J Urol 2010; 28:53-62. [PMID: 20052586 DOI: 10.1007/s00345-009-0504-z] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 12/24/2009] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Laser techniques for the treatment of bladder outlet obstruction (BOO) due to benign prostate enlargement (BPE) have emerged as an alternative to transurethral resection of the prostate (TURP) and open prostatectomy (OP). MATERIALS AND METHODS A Medline search over the past 4 years was performed to assess the safety, intra- and postoperative morbidity of various laser techniques. RESULTS Data on holmium laser enucleation of the prostate (HoLEP) show the highest grade of evidence with two meta-analyses available and prove the low intra- and postoperative morbidity with reproducible long-term results. Photoselective vaporization of the prostate (PVP) with the Greenlightlaser (potassium titanyl phosphate, KTP or lithium borate, LBO) is characterized by excellent haemostatic properties in patients with or without oral anticoagulation. Long-term results show a reoperation rate comparable with TURP; however, there is a lack of randomized trials. Various types of diode lasers with different wavelengths are available for laser vaporization; despite their favourable haemostatic properties, a higher invasion depth seems to result in necrosis of the tissue leading to a higher rate of reoperation. Thulium-laser resection of the prostate shows promising intra- and postoperative morbidity, but data are limited and initial results need to be confirmed in large-scale trials. CONCLUSION In summary, HoLEP- and KTP-, or LBO-laser vaporization of the prostate are the most mature techniques of laser prostatectomy and treatment alternatives to TURP and OP, whereas the clinical value and durability of procedures with diode laser systems and the thulium laser need to be confirmed in high-quality prospective RCTs.
Collapse
Affiliation(s)
- Malte Rieken
- Department of Urology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland.
| | | | | | | | | |
Collapse
|
33
|
A Review of the Recent Evidence (2006–2008) for 532-nm Photoselective Laser Vaporisation and Holmium Laser Enucleation of the Prostate. Eur Urol 2009; 55:1345-57. [DOI: 10.1016/j.eururo.2009.03.070] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Accepted: 03/16/2009] [Indexed: 01/18/2023]
|
34
|
Hai MA. Photoselective Vaporization of Prostate: Five-year Outcomes of Entire Clinic Patient Population. Urology 2009; 73:807-10. [DOI: 10.1016/j.urology.2008.08.502] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 08/06/2008] [Accepted: 08/12/2008] [Indexed: 11/29/2022]
|
35
|
Kavoussi PK, Hermans MR. Maintenance of Erectile Function after Photoselective Vaporization of the Prostate for Obstructive Benign Prostatic Hyperplasia. J Sex Med 2008; 5:2669-71. [DOI: 10.1111/j.1743-6109.2008.00978.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
36
|
Lombardi G, Mondaini N, Giubilei G, Macchiarella A, Lecconi F, Del Popolo G. Sacral Neuromodulation for Lower Urinary Tract Dysfunction and Impact on Erectile Function. J Sex Med 2008; 5:2135-40. [DOI: 10.1111/j.1743-6109.2008.00948.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|