V325 NEW ASPECTS OF EJACULATION AND ITS SIGNIFICANCE: EJACULATION PRESERVING TRANSURETHRAL RESECTION AND LASERVAPORESECTION OF THE PROSTATE

Abstract

You have accessJournal of UrologyMale Voiding Dysfunction (BPH & Incontinence) & Infection1 Apr 2010V325 NEW ASPECTS OF EJACULATION AND ITS SIGNIFICANCE: EJACULATION PRESERVING TRANSURETHRAL RESECTION AND LASERVAPORESECTION OF THE PROSTATE Christoph Lang, Awad Al-Kaabneh, Robert Eichel, Saladin Helmut Alloussi, and Schahnaz Alloussi Christoph LangChristoph Lang More articles by this author , Awad Al-KaabnehAwad Al-Kaabneh More articles by this author , Robert EichelRobert Eichel More articles by this author , Saladin Helmut AlloussiSaladin Helmut Alloussi More articles by this author , and Schahnaz AlloussiSchahnaz Alloussi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.390AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Clinical, physiological and anatomical findings have resulted in challenging the current theory of the ejaculation mechanism. Videourodynamic observations in patients with opened internal bladder neck are able to ejaculate antegradely and patients with loss of ejaculation after retroperitoneal lymphadenectomy presented a closed internal bladder neck. Anatomic and histological examinations could confirm a musculus ejaculatorius to bring into line the colliculus seminalis. Due to the findings and understanding of ejaculation mechanism a new technique in TUR (epTUR) and Laservaporesection (epLaVaP) of the prostate is established. This video is performed to present the functional aspects of ejaculation and the resection techniques. METHODS Since 1996 in 197 patients, aged 27 to 78 years an ejaculation preserving technique of the prostate is performed, since 2001 87 patients in a prospectiv study with 5 year follow up control and since 2008 in 22 patients by laservaporesection. The functional outcome is controlled by uroflow, residual volume, International Prostate Symptom Score (IPSS) and Live Quality Index (LQI). The ejaculate is controlled in the first 50 patients by seminal fluid analysis and for all patients by questionnaire IIEF 5+. RESULTS In 92% of patients, treated by epTUR-P and epLaVaP for bladder outlet obstruction the orthograde ejaculation could be preserved. In seminal fluid analysis a reduction of volume of 30% is shown. Micturition symptoms show a substantial improvement as objective parameters like uroflow and residual volume presented in table 1. Table 1. Functional results of epTUR-P with 5 year follow up, n=87 Preop Postop Follow-up IPSS 23 7 4.7 LQI 4.7 2 1.5 Uroflow [ml/s] 7 24 24 Residual [ml] 52 13 12.5 CONCLUSIONS Ejaculation preserving treatment of the prostate by endoscopic resection is possible. The presented techniques are suitable for ejaculation preservation. The functional outcome is excellent and could be confirmed in long term follow up for epTUR-P. The internal bladder neck is irrelevant for orthogradic ejaculation. No incontinence could be observed. The old concept of ejaculation physiology must be reviewed. Neunkirchen, Germany© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e129 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christoph Lang More articles by this author Awad Al-Kaabneh More articles by this author Robert Eichel More articles by this author Saladin Helmut Alloussi More articles by this author Schahnaz Alloussi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...