Evaluation of the Effect of Photoselective Vaporization of the Prostate on Sexual Function in a Prospective Study: A Single Center Experience of 150 Patients.

Abstract

Abstract Background and Purpose: Photoselective vaporization of the prostate (PVP) has emerged as a minimally invasive alternative to transurethral resection of the prostate for treatment of benign prostate hyperplasia (BPH) with lower urinary tract symptoms (LUTS). Very few prospective studies have addressed the effect of PVP on sexual function. We performed this prospective study to assess the short-term effect of PVP on erectile function in patients who present with LUTS secondary to BPH. Patients and Methods: There were 150 consecutive patients who presented with LUTS secondary to BPH who underwent PVP and who were enrolled prospectively in this study. Patients were categorized in two groups: Group A, International Index of Erectile Function (IIEF) ≥19; group B, IIEF <19. PVP was performed by using an 80 W GreenLight laser. Patients preoperative, perioperative, and follow-up data were recorded. Erectile function was assessed preoperatively and postoperatively at 1, 3, 6, and 12 months using IIEF-5. In follow-up, Ultrasonography of the kidneys, ureters, and bladder for residual prostate and postvoid residual urine, uroflowmetry, kidney function tests, and urine culture were performed at each visit. Cystoscopy was performed at 3 months. Data were analyzed statistically. Results: The two patient groups were comparable in their preoperative and perioperative data. Both groups showed improvement in International Prostate Symptom Score, maximum flow rate, quality of life, and decrease in postvoid residual urine at 1, 3, 6, and 12 months with no statistical significance. IIEF-5 scores in Group A, however, were 21.1, 19.2, 17.1, 16.2, and 16.1, respectively, at preoperative, postoperative month 1, 3, 6, and 12, respectively (P=0.02). IIEF-5 scores in Group B were 13.2, 12.1, 11.3, 11.2, and 10.9, respectively, at preoperative, postoperative month 1, 3, 6, and 12, respectively (P=0.45). Conclusions: In patients with normal preoperative erectile function, PVP resulted in significant decrease in EF up to follow-up of 1 year. In patients with preoperative ED, however, PVP did not significantly decrease EF.