Assessment of Sexual Outcomes in Patients Undergoing Thulium Laser Prostate Surgery for Management of Benign Prostate Hyperplasia: A Systematic Review and Meta-analysis.

Bibo Li,Conghui Han,Jianjun Zhang,Jian Wang,Chendi Yang,Lin Hao,Guanghui Zang,Xitao Wang,Kun Pang,Longjun Cai

doi:10.1016/j.esxm.2021.100483

Abstract

BackgroundThulium laser (Tm:YAG) prostate surgery is a safe and effective procedure with low morbidity and comparable clinical outcomes to those of transurethral resection of the prostate (TURP). However, the sexual function outcomes (erectile and ejaculatory function) have been scarcely studied.AimWe aimed to assess the impact of Tm:YAG prostate surgery on sexual outcomes (erectile and ejaculatory function) and compare them with those patients undergoing TURP.Material and MethodsWe searched digital databases like PUBMED, SCOPUS, CENTRAL and EMBASE using relevant keywords to identify comparative studies on TURP and non-comparative studies on Tm:YAG prostate surgery that assessed sexual outcomes. We performed qualitative and quantitative analyses with the extracted data. We carried out a meta-analysis to compare postoperative International Index of Erectile Function (IIEF-5) scores and incidences of retrograde ejaculation (RE) in patients undergoing either Tm:YAG or TURP. The pre-operative and post-operative IIEF-5 scores were pooled to estimate overall scores.ResultsWe included 5 comparative and 8 non-comparative studies in this review. We found the postoperative IIEF-5 score improvements to be significantly higher in the Tm:YAG prostate surgery group than in the TURP group with a significant mean difference (MD) of 0.45 (95% CI, 0.18 to 0.72; P = .001). We found no significant associations between the procedures. The pooled OR for the association of RE was estimated at 0.90 (95% CI, 0.50 to 1.60; P = .71; I2 = 0%).ConclusionTm:YAG prostate surgery improves erectile function more than TURP, according to our findings. Tm:YAG prostate aided surgery also outperforms TURP in terms of preserving sexual function following surgery.However, We found similar or no difference in incidence of RE between Tm:YAG prostate surgery and TURP.Bibo L, Hao L, Pang K, et al. Assessment of Sexual Outcomes in Patients Undergoing Thulium Laser Prostate Surgery for Management of Benign Prostate Hyperplasia: A Systematic Review and Meta-analysis. Sex Med 2022;10:100483.

Highlights

Benign prostatic hyperplasia (BPH) causes lower urinary tract symptoms in most elderly men.[1]
We found the postoperative IIEF-5 score improvements to be significantly higher in the Thulium laser (Tm):YAG prostate surgery group than in the Transurethral resection of prostate (TURP) group with a significant mean difference (MD) of 0.45
Tm:YAG prostate aided surgery outperforms TURP in terms of preserving sexual function following surgery.We found similar or no difference in incidence of retrograde ejaculation (RE) between Tm:YAG prostate surgery and TURP

Summary

Introduction

Benign prostatic hyperplasia (BPH) causes lower urinary tract symptoms in most elderly men.[1]. Transurethral resection of prostate (TURP) is the gold standard surgical treatment; during the procedure the prostate lobes are resected with a trans-urethral resectoscope without any incisions.[6] TURP is both efficient and effective, but it is associated with morbidities like bleeding, urinary incontinence, and fluid loss.[6] During the last 2 decades, minimally invasive techniques, including the use of lasers like Holmium (Ho:YAG) and Thulium (Tm:YAG)-assisted vapo-enucleation, vapo-resection, resection, or enucleation, have evolved to decrease morbidity and achieve comparable surgical outcomes.[7,8]. Multiple techniques including thulium laser resection of prostate (TmLRP), thulium laser enucleation of prostate (TmLEP), vapo-enucleation (TmVEP), and vaporization (TmVP) have been described and appear to be safe and effective with low morbidity.[8,10] Based on the findings of comparative studies, Tm:YAG seem to provide better hemostasis, less overall morbidity, shorter catheterization times, and a shorter hospital stay than the traditional TURP.[10,11]. The sexual function outcomes (erectile and ejaculatory function) have been scarcely studied

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