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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.
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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
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Dornbier R, Pahouja G, Branch J, McVary KT. The New American Urological Association Benign Prostatic Hyperplasia Clinical Guidelines: 2019 Update. Curr Urol Rep 2020; 21:32. [PMID: 32607874 DOI: 10.1007/s11934-020-00985-0] [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: 12/18/2022]
Abstract
PURPOSE OF REVIEW The goal of this paper was to analyze the efficacy of the current modalities available to surgically treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). RECENT FINDINGS There have been significant surgical advancements for the treatment of BPH, including an increasing development and utilization of minimally invasive surgical techniques (MISTs). These procedures have varying outcomes that are critical to understand. In addition, MISTs have important adverse effects, though have minimized effects on sexual function when compared to more invasive surgical techniques. It is important for all urologists to be familiar with the surgical techniques available to treat BPH and the updated American Urological Association (AUA) Guidelines. Further studies evaluating efficacy, safety, and sexual functioning will help guide care in the future and evolve practice.
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Affiliation(s)
- Ryan Dornbier
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA.
| | - Gaurav Pahouja
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA
| | - Jeffrey Branch
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA
| | - Kevin T McVary
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA
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Huet R, Peyronnet B, Khene ZE, Freton L, Verhoest G, Manunta A, Bensalah K, Vincendeau S, Mathieu R. Prospective Assessment of the Sexual Function After Greenlight Endoscopic Enucleation and Greenlight 180W XPS Photoselective Vaporization of the Prostate. Urology 2019; 131:184-189. [PMID: 31254569 DOI: 10.1016/j.urology.2019.06.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate the impact of Greenlight 180W photoselective vaporization of the prostate (PVP) and endoscopic enucleation of the prostate (GreenLEP) on ejaculatory and erectile functions. MATERIALS AND METHODS Between January 2014 and September 2016, 440 men with low urinary tract symptoms or complications related to benign prostate obstruction with prostate >80 g and sexually active, underwent a PVP or GreenLEP performed by experienced surgeons at a single institution. Patients were matched in a 1:1 fashion according to preoperative transrectal ultrasonography prostatic volume and cardiovascular risk factors (smoking, diabetes, and hypertension). RESULTS One hundred patients in each group were included. Mean prostatic volume were 110 g (95%CI: 101-118) and 107 g (95%CI: 99-115) in the GreenLEP and PVP groups, respectively (P = .68). Mean total energy delivered in the PVP group was 4.42 kJ/g (4.2-4.6). Surgical retreatment was required in 9 patients (10.1%) in the PVP group and none in the GreenLEP group (log rank test: P = .002). Mean prostate specific antigen level and International Prostate Symptom Score score were significantly lower in the GreenLEP group than in the PVP group at 3, 12, and 24 months (P <.001). Preserved antegrade ejaculation was reported in 24 patients (26.9%) in the PVP group vs 1 patient (1.2%) in the GreenLEP group at 12 months (P <.001). In multivariate analysis, age, history of coronary artery disease, and surgical treatment with PVP were independent factors of IIEF-5 decline. CONCLUSION Despite a poor rate of preserved antegrade ejaculation, GreenLEP was associated with better erectile function outcomes possibly due to greater improvement of low urinary tract symptoms.
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Affiliation(s)
- Romain Huet
- Department of Urology, Rennes University Hospital, University of Rennes 1, Rennes, France
| | - Benoit Peyronnet
- Department of Urology, Rennes University Hospital, University of Rennes 1, Rennes, France.
| | - Zine-Eddine Khene
- Department of Urology, Rennes University Hospital, University of Rennes 1, Rennes, France
| | - Lucas Freton
- Department of Urology, Rennes University Hospital, University of Rennes 1, Rennes, France
| | - Grégory Verhoest
- Department of Urology, Rennes University Hospital, University of Rennes 1, Rennes, France
| | - Andréa Manunta
- Department of Urology, Rennes University Hospital, University of Rennes 1, Rennes, France
| | - Karim Bensalah
- Department of Urology, Rennes University Hospital, University of Rennes 1, Rennes, France
| | - Sébastien Vincendeau
- Department of Urology, Rennes University Hospital, University of Rennes 1, Rennes, France
| | - Romain Mathieu
- Department of Urology, Rennes University Hospital, University of Rennes 1, Rennes, France
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Abstract
As men age, there is an increased incidence of lower urinary tract symptoms (LUTS), often from benign prostatic hyperplasia (BPH) which can adversely affect sexual function. There are many different treatments for these symptoms; however, many of the treatments also affect sexual quality of life, specifically in the realm of ejaculation. Our paper will review the medications, surgical procedures, minimally invasive procedures, and even investigational procedures used to treat LUTS/BPH and the effect they have on ejaculation. The aim of this paper is to help practitioners counsel patients more effectively on treatment options when ejaculation is a concern.
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Affiliation(s)
- Michelle Herberts
- Division of Urology, Southern Illinois University School of Medicine, 301 N 8th St-4th Floor, PO Box 19665, Springfield, IL, 62794-9665, USA
| | | | - Tobias Köhler
- Division of Urology, Southern Illinois University School of Medicine, 301 N 8th St-4th Floor, PO Box 19665, Springfield, IL, 62794-9665, USA.
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Elhilali MM, Elkoushy MA. Greenlight laser vaporization versus transurethral resection of the prostate for the treatment of benign prostatic obstruction: evidence from randomized controlled studies. Transl Androl Urol 2016; 5:388-92. [PMID: 27298788 PMCID: PMC4893504 DOI: 10.21037/tau.2016.03.09] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Mostafa M Elhilali
- 1 Department of Surgery, Division of Urology, McGill University, Montreal, QC, Canada ; 2 Department of Urology, Suez Canal University, Ismailia, Egypt
| | - Mohamed A Elkoushy
- 1 Department of Surgery, Division of Urology, McGill University, Montreal, QC, Canada ; 2 Department of Urology, Suez Canal University, Ismailia, Egypt
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The Impact of Medical and Surgical Treatment for Benign Prostatic Hypertrophy on Erectile Function. Curr Urol Rep 2015; 16:80. [PMID: 26438220 DOI: 10.1007/s11934-015-0549-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There is a well-known link between treatment for lower urinary tract symptoms (LUTS) and erectile dysfunction. Surgical and medical management of LUTS all have side effect profiles which may affect erectile dysfunction, ejaculatory dysfunction, or libido. These should be taken into consideration during patient counseling. This article reviews the common side effects of the medical and surgical treatments of LUTS.
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Brunken C, Seitz C, Woo HH. A systematic review of experience of 180-W XPS GreenLight laser vaporisation of the prostate in 1640 men. BJU Int 2015; 116:531-7. [PMID: 25307850 DOI: 10.1111/bju.12955] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To systematically review the literature regarding clinical outcomes of 180-W XPS GreenLight laser (GL) vaporisation for the treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). METHODS Recent publications were identified in the field of 180-W GL vaporisation for the treatment of LUTS due to BPH. We searched for peer-reviewed original articles in the English language. Search items were: '180W lithium triborate laser' or '180W greenlight laser' or '180 watt lithium triborate laser' or '180 watt greenlight laser' or 'XPS greenlight laser'. In all, 30 papers published between 2012 and 2014 matched this search. Of these, 10 papers were identified dealing with consecutive cohorts of patients treated with the 180-W XPS GL RESULTS: The 10 papers included a total experience of 1640 patients. The only randomised controlled trial in this field compares 180-W with transurethral resection of the prostate (TURP). Functional outcomes and prostate volume reduction after GL vaporisation were similar to TURP. Catheterisation time and hospital stay were shorter in patients undergoing 180W XPS GL vaporisation (41 and 66 h vs 60 and 97 h, respectively). Four papers compared the 180-W XPS system to former GL devices showing increased operation time efficiency and comparable postoperative voiding results and adverse events. One paper defined the learning curve to achieve an expert level according to the speed of the procedure and the effectiveness of volume reduction was met after 120 procedures. CONCLUSION The 180-W XPS GL offers shorter operation times than former devices. In the one randomised controlled trial comparison with TURP, volume reduction and functional results were comparable to those of TURP. Longer term studies are required.
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Affiliation(s)
- Claus Brunken
- Department of Urology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Christian Seitz
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Henry H Woo
- Sydney Adventist Hospital Clinical School University of Sydney, Wharoonga, NSW, Australia
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Bachmann A, Tubaro A, Barber N, d’Ancona F, Muir G, Witzsch U, Grimm MO, Benejam J, Stolzenburg JU, Riddick A, Pahernik S, Roelink H, Ameye F, Saussine C, Bruyère F, Loidl W, Larner T, Gogoi NK, Hindley R, Muschter R, Thorpe A, Shrotri N, Graham S, Hamann M, Miller K, Schostak M, Capitán C, Knispel H, Thomas JA. A European Multicenter Randomized Noninferiority Trial Comparing 180 W GreenLight XPS Laser Vaporization and Transurethral Resection of the Prostate for the Treatment of Benign Prostatic Obstruction: 12-Month Results of the GOLIATH Study. J Urol 2015; 193:570-8. [DOI: 10.1016/j.juro.2014.09.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Alexander Bachmann
- Department of Urology Basel, University Hospital Basel, University Basel, Basel, Switzerland
| | - Andrea Tubaro
- Department of Urology, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Neil Barber
- Department of Urology, Frimley Park Hospital, Frimley, Camberley
| | - Frank d’Ancona
- Department of Urology, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Gordon Muir
- Department of Urology, King’s College Hospital and King’s Health Partners, London
| | - Ulrich Witzsch
- Department of Urology and Pediatric Urology, Krankenhaus Nordwest, Frankfurt, Germany
| | | | - Joan Benejam
- Department of Urology, Hospital de Manacor, Manacor, Spain
| | | | - Antony Riddick
- Department of Urology, Lothian University Hospitals Division, Western General Hospital, Edinburgh
| | - Sascha Pahernik
- Department of Urology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Herman Roelink
- Department of Urology, Ziekenhuis Groep Twente, Almelo/Hengelo, The Netherlands
| | - Filip Ameye
- Department of Urology, AZ Maria Middelares Gent, Gent, Belgium
| | - Christian Saussine
- Department of Urology, Nouvel Hopital Civil de Strasbourg, Strasbourg University, Strasbourg, France
| | - Franck Bruyère
- Department of Urology, CHRU Bretonneau, Tours, Loire Valley and Université François Rabelais de Tours, PRES Centre- Val de Loire Université, Val de Loire, France
| | - Wolfgang Loidl
- Department of Urology, Krankenhaus der Barmherzigen Schwestern Linz, Linz, Austria
| | - Tim Larner
- Department of Urology, Brighton and Sussex University Hospitals NHS Trust, Brighton
| | - Nirjan-Kumar Gogoi
- Department of Urology, Mid Yorkshire NHS Trust, Dewsbury & District Hospital, Dewsbury
| | - Richard Hindley
- Department of Urology, Basingstoke and North Hampshire NHS Foundation Trust, Hampshire
| | - Rolf Muschter
- Department of Urology, Diakoniekrankenhaus Rotenburg, Rotenburg, Germany
| | - Andrew Thorpe
- Department of Urology, Freeman Hospital Newcastle, Newcastle upon Tyne
| | - Nitin Shrotri
- Department of Urology, Kent and Canterbury Hospital, Kent
| | - Stuart Graham
- Department of Urology, Whipps Cross University Hospital, London
| | - Moritz Hamann
- Department of Urology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - Martin Schostak
- Department of Urology, University Hospital Magdeburg, Magdeburg, Germany
| | - Carlos Capitán
- Department of Urology, Hospital Universitario Fundacion Alcorcon, Madrid, Spain
| | - Helmut Knispel
- Department of Urology, Uro-Forschungs GmbH im St. Hedwig Krankenhaus, Berlin, Germany
| | - J. Andrew Thomas
- Department of Urology, ABMU LHB, Princess of Wales Hospital, Bridgend, Wales
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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
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Cornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, McVary K, Novara G, Woo H, Madersbacher S. A Systematic Review and Meta-analysis of Functional Outcomes and Complications Following Transurethral Procedures for Lower Urinary Tract Symptoms Resulting from Benign Prostatic Obstruction: An Update. Eur Urol 2014; 67:1066-1096. [PMID: 24972732 DOI: 10.1016/j.eururo.2014.06.017] [Citation(s) in RCA: 502] [Impact Index Per Article: 50.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 06/12/2014] [Indexed: 10/25/2022]
Abstract
CONTEXT A number of transurethral ablative techniques based on the use of innovative medical devices have been introduced in the recent past for the surgical treatment of benign prostatic obstruction (BPO). OBJECTIVE To conduct a systematic review of the literature and a meta-analysis of available randomized controlled trials (RCTs), and to evaluate the efficacy and safety of transurethral ablative procedures for BPO. EVIDENCE ACQUISITION A systematic literature search was performed for all RCTs comparing any transurethral surgical technique for BPO to another between 1992 and 2013. Efficacy was evaluated after a minimum follow-up of 1 yr based on International Prostate Symptom Score, maximum flow rate, and postvoid residual volume. Efficacy at midterm follow-up, prostate volume, perioperative data, and short-term and long-term complications were also assessed. Data were analyzed using RevMan software. EVIDENCE SYNTHESIS A total of 69 RCTs (8517 enrolled patients) were included. No significant difference was found in terms of short-term efficacy between bipolar transurethral resection of the prostate (B-TURP) and monopolar transurethral resection of the prostate (M-TURP). However, B-TURP was associated with a lower rate of perioperative complications. Better short-term efficacy outcomes, fewer immediate complications, and a shorter hospital stay were found after holmium laser enucleation of the prostate (HoLEP) compared with M-TURP. Compared with M-TURP, GreenLight photoselective vaporization of the prostate (PVP) was associated with a shorter hospital stay and fewer complications but no different short-term efficacy outcomes. CONCLUSIONS This meta-analysis shows that HoLEP is associated with more favorable outcomes than M-TURP in published RCTs. B-TURP and PVP have resulted in better perioperative outcomes without significant differences regarding efficacy parameters after short-term follow-up compared with M-TURP. Further studies are needed to provide long-term comparative data and head-to head comparisons of emerging techniques. PATIENT SUMMARY Bipolar transurethral resection of the prostate, photovaporization of the prostate, and holmium laser enucleation of the prostate have shown efficacy outcomes comparable with conventional techniques yet reduce the complication rate. The respective role of these new options in the surgical armamentarium needs to be refined to propose tailored surgical treatment for benign prostatic obstruction relief.
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Affiliation(s)
- Jean-Nicolas Cornu
- Department of Urology, Tenon Hospital, University Paris 6, Assistance Publique-Hopitaux de Paris, Paris, France.
| | - Sascha Ahyai
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Jean de la Rosette
- Department of Urology, AMC University Hospital, Amsterdam, The Netherlands
| | - Peter Gilling
- Department of Urology, Tauranga Hospital, Tauranga, New Zealand
| | - Christian Gratzke
- Department of Urology, Urologische Klinik und Poliklinik, Klinikum der Universität München-Großhadern, Munich, Germany
| | - Kevin McVary
- Department of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Giacomo Novara
- Department of Surgery, Oncology, and Gastroenterology-Urology Clinic, University of Padua, Padua, Italy
| | - Henry Woo
- Department of Urology, Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, Australia
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