2013 EJACULATION PRESERVING TRANS URETHRAL RESECTION OF PROSTATE A PILOT STUDY

Abstract

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology II1 Apr 20122013 EJACULATION PRESERVING TRANS URETHRAL RESECTION OF PROSTATE A PILOT STUDY Srinath Chandrasekera, Surendra De Zylva, Nilanganie Lamahewage, and Maheesha Kulasinghe Srinath ChandrasekeraSrinath Chandrasekera Nugegoda, Sri Lanka More articles by this author , Surendra De ZylvaSurendra De Zylva Colombo, Sri Lanka More articles by this author , Nilanganie LamahewageNilanganie Lamahewage Colombo, Sri Lanka More articles by this author , and Maheesha KulasingheMaheesha Kulasinghe Nugegoda, Sri Lanka More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2176AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite numerous advances seen in surgery for BPH, retrograde ejaculation remains as the commonest and unconquered morbidity. Given an option most sexually active men undergoing TURP are likely to prefer to have their ejaculation preserved. The objective of this study was to assess the safety and feasibility of our technique of “Ejaculation Preserving TURP” and evaluate short term outcomes. Our study was based on the hypothesis that occluding supra montal prostatic adenoma plays a role in maintaining antegrade ejaculation in men with prostatic obstruction. METHODS We assessed fifteen sexually active males aged 51 to 66 (mean-58.5 years) undergoing Ejaculation Preserving TURP. Mean prostatic volume was 37.6ml (range 12-59ml). Nine were due to failed medical therapy and 6 were in refractory urinary retention. Bipolar TURP was done resecting adenoma at bladder neck including median lobe when present and prostatic urethra. Two small cushions of adenoma and prostatic mucosa were preserved at the prostatic apex and a few millimeters of prostatic urethral mucosa just above the veru montanum. Care was taken not to create “flap valves”. We used a scoring system to assess the degree of projection of the ejaculate “Ejaculation Projection Score”. ie:0=no ejaculation, 1=few drops only, 2=non projectile, 3=projectile, 4=strongly projectile. Patients were assessed pre operatively, at 6 weeks, 3 months, 6 months and 12 months. RESULTS At one year their mean maximum flow rates improved from 6.3ml/S to 22ml/S (p=0.000),residual urine volumes from 120ml to 34ml (p=0.000),IPSS scores from 25 to 5.8 (p=0.000) and quality of life scores from 5.2 to 1.2 (p=0.000). Strikingly, the ejaculatory function remained unchanged (IIEF question 9) from 4 to 3.5 (p=0.02) and “ejaculation projection score” from 3.3 to 3.1 (p=0.57).IIEF score remained unchanged from 54 to 56.4 (p=0.29). 12 /15 had no change or improved ejaculation following surgery and cessation of medical therapy denoting a success rate of 80%.1/15 had complete loss of ejaculation while 2/15 had reduced ejaculation. There were no major morbidities or mortality. CONCLUSIONS Ejaculation Preserving TURP is a safe and feasible option with promising initial results. Our success with various sized adnomata even in those with urinary retention implies the satisfactory degree of unblocking of the outflow with this technique whist preserving antegrade ejaculation. Results of this study further confirms the role of the supra montal prostatic adenoma in maintaining antegrade ejaculation in those with obstructing BPH. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e813 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Srinath Chandrasekera Nugegoda, Sri Lanka More articles by this author Surendra De Zylva Colombo, Sri Lanka More articles by this author Nilanganie Lamahewage Colombo, Sri Lanka More articles by this author Maheesha Kulasinghe Nugegoda, Sri Lanka More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...