Ejaculation-sparing thulium laser enucleation of the prostate (ES-ThuLEP): outcomes on a large cohort.

Giorgio Bozzini,Umberto Besana,Carlo Buizza,Paolo Broggini,Antonio Luigi Pastore,Alexander Müller,Maria Chiara Sighinolfi,Alberto Calori,Lorenzo Berti,Rodrigo Ledezma,Salvatore Micali,Matteo Maltagliati,Bernardo Rocco

doi:10.1007/s00345-020-03442-2

Abstract

To assess the effects of a new ejaculation-sparing thulium laser enucleation of the prostate (ES-ThuLEP) technique on sexual functions and micturition, in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) and to evaluate how the surgical technique of ES-ThuLEP can lead to ejaculation preservation. A prospective study was carried out between January 2015 and January 2018 on patients with surgical indication for BPH, who wished to preserve ejaculation. The patients were treated with ES-ThuLEP and were evaluated before and 3 and 6months after surgery. Three validated questionnaires (ICIQ-MLUTSsex, IIEF-5 and IPSS) were used to assess changes in ejaculation, erectile function and urinary symptoms. Uroflowmetry (Qmax and Qavg), post-void residual volume and voided volume were also evaluated, to assess micturition improvement. Patients with moderate to severe erectile dysfunction were excluded. Statistical analysis was performed with the Student's t test, Chi-square test and logistic regression analysis. Two hundred and eighty three patients were enrolled. Ejaculation was spared in 203 and 219 patients at 3 and 6months after surgery. No significant differences were observed between erectile function before and after surgery: baseline IIEF-5 = 16.2 ± 4.47 vs 16.7 ± 2.9 (p = 0.419) and 17.7 ± 3.2 (p = 0.410) at 3 and 6months. Significant improvement in urinary symptoms was achieved: baseline IPSS = 19.4 ± 7.24 vs 5.8 ± 4.3 (p = 0.032) and 3.9 ± 4.1 (p = 0.029) at 3 and 6months. ES-ThuLEP effectively preserved ejaculation in over two thirds of the patients without compromising micturition improvement or erectile function. ES-ThuLEP could be a valid treatment option for BPH in young and sexually active men.

Highlights

Benign prostatic hyperplasia (BPH) is a common condition in aging men, which leads to lower urinary tract symptoms (LUTS) and sexual dysfunction, negatively impacting on the patients’ quality of life [1, 2]
Over the past three decades research has focused on the developement of new surgical strategies to reduce morbidity and complications of conventional surgical procedures, such as transurethral resection of the prostate (TURP) and open prostatectomy (OP), but in most cases overlooking the impact on the patients’ ejaculatory function
A prospective study was carried out between January 2015 and January 2018 on patients suffering from LUTS secondary to BPH, with surgical indication according to EAU Guidelines [11], who wished to preserve ejaculation

Summary

Introduction

Benign prostatic hyperplasia (BPH) is a common condition in aging men, which leads to lower urinary tract symptoms (LUTS) and sexual dysfunction, negatively impacting on the patients’ quality of life [1, 2]. Holmium laser enucleation of the prostate (HoLEP) [5] and thulium laser enucleation of the prostate (ThuLEP) [6] are the most demanded laser EEP techniques (LEEP) Both determine excellent resolution of LUTS and improvement in voiding parameters, comparable to those of TURP and OP, but with reduced morbidity, catheterization time and hospital stay. They allow to treat prostates of virtually all sizes [7,8,9,10]. Despite the well documented advantages of LEEP techniques over TURP and OP, they have not been able to overcome postoperative ejaculatory dysfunction (EjD) [12, 13]

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Conclusion