Antegrade Ejaculation Preservation Technique with GreenLight XPS 180-W: Functional Ejaculatory Results.

Abstract

Introduction: Ejaculatory dysfunction is a common complication of surgeries for benign prostatic obstruction. It causes a clear deterioration in quality of life. Techniques have been developed to attempt to preserve antegrade ejaculation (AE). Our objective was to analyze results of ejaculatory function using an AE preservation technique during anatomical vaporization with XPS 180-W. Methods: Between 2017 and 2019, sexually active patients were treated using this technique by the same surgical team. A questionnaire (MSHQ-EjD Short Form) was mailed, patients who did not answer were contacted by phone or personally during follow-up. Responses were analyzed. Voiding function was evaluated using International Prostatic Symptoms Score (IPSS), Qmax, and postvoid residual volume. t-Test for paired samples was used to compare conformity of patients with and without AE and voiding results. A p < 0.05 was considered statistically significant. Results: In total, 77 of 112 patients (68.8%) completed questionnaires and were included. Mean age was 64.1 years (standard deviation [SD] 6.9) and median prostate size was 57.2 g (interquartilic range 30-85). A total of 68 of 77 (88.3%) patients reported AE. Of these, 58 (85.3%) reported AE always or most of the time and 10 (14.7%) reported AE half of the time. In total, 42 (61.7%) patients had preserved strength or slightly less than before the procedure, and 33 (48.5%) reported the same or slightly less volume than before. In terms of satisfaction, the average response values of patients with preserved AE and ejaculatory disfunction were 0.97 (SD 1.12) and 2.7 (SD 1.78), respectively (p = 0.000). Pre- and postoperative variables were as follows: mean Qmax was 11.6 mL/sec vs 19.6 (p = 0.00), mean IPSS was 13.8 vs 8.9 (p = 0.000), and mean postvoiding residual urine was 125.3 vs 33.1 mL (p = 0.00), respectively. Conclusion: It is feasible to perform the AE preservation technique with anatomical vaporization XPS 180-W. In our medium size prostate series, we had a satisfactory patient perception of the ejaculatory function and satisfactory voiding function results.