Risk of orgasmic function decrease after holep – results from a prospective trial (expho)

Abstract

Laser enucleation of the prostate is associated with an invariable risk of retrograde ejaculation which could affect patient’ sexual life with negative impact on orgasmic function (OF). We investigated OF outcomes after Holmium Laser Enucleation of the Prostate (HoLEP) in patients consecutively treated at a single center. The ExpHo trial (NCT03583034) is a prospective observational study collecting data of patients submitted to HoLEP at a single center. Surgeries were performed by a single highly experienced surgeon. Before surgery, all patients completed the International Index of Erectile Function (IIEF) thus including the OF domain. Non-sexually active patients were excluded. Patients were re-assessed at 1 week, 1-, 3-, 6- and 12-mos. Kaplan-Meier analyses estimated OF recovery over time (defined as: IEF-OF score>= than baseline). Logistic regression model was used to test baseline characteristics associated with the risk of reporting a worse OF after surgery. Data were available for 135 patients. Median (IQR) age was 66 (62,73) years. Median prostate volume (PV) 81 cc (63, 110). Overall, 46 (64%) patients complained of ED before surgery. Median(IQR) IIEF-OF score at baseline was 6(0, 10). We observed a significant decrease in mean IIEF-OF score at 1-mo follow-up compared to baseline (6.1 vs. 3.; p=<0.0001) with a subsequent improvement at 3-mo (IIEF-OF: 5.4) and 6-mo (IIEF-EF: 5.9). The estimated (95%CI) OF recovery rates post-HoLEP were 44%(35,54), 62%(53,72) and 77%(66,86) at 1-,3- and 12-mos follow-up. Overall, 34%(46) reported a decreased OF after surgery. Younger patients (OR: 0.91, 95%CI:0.8-0.9;p=0.03) and those with normal pre-operative EF (OR:3.4,95%CI1.1,11.5;p=0.04) showed higher risk of reporting a decrease of OF after surgery. One out three patients reported a decrease in OF after HoLEP. Younger patients with normal baseline EF should be carefully counselled regarding the risk of retrograde ejaculation associated with laser enucleation of the prostate. None