Preservation Of Ejaculation Research Articles

Aquablation at 4-years: Real World Data From the Largest Single-center Study With Associated Outcomes Follow-up

ObjectivesTo report real-world experience of 4-year safety and efficacy outcomes of Aquablation procedure for the treatment of men with symptomatic benign prostatic hyperplasia (BPH). MethodsThis is a prospective single-center, observational study evaluating the outcomes of robotic-assisted Aquablation therapy for moderate-to-severe BPH between December 2019 and December 2023. Patient-level data included age, prostate volume, IPSS score, peak urinary flow rate (Qmax), post-void residual (PVR) were evaluated at 3M, 6M, and Years 1 - 4. Primary outcomes included change in IPSS score, change in Qmax, change in PVR, preservation of antegrade ejaculation, and complications. ResultsIn this cohort of 330 men, mean prostatic volume was 110.3 mL (range 38-330 mL) at baseline. International Prostate Symptom Score (IPSS) improved from a baseline of 23.8 (SD 8.4) to 6.9 (SD 2.9) at 4 years. Mean peak urinary flow rate (Qmax) also demonstrated improvement and increased from 6.4 ml/sec (SD 4.2) to 17.4 ml/sec (SD 5.5) at 4 years. At one year, mean prostate volume reduction was 45.5 mL (-41.3%). Postoperative antegrade ejaculation was preserved in 249/250 men (99.6)% of men. Complications included urinary tract infection within first month after procedure in 37 (11.2%) and bleeding requiring blood transfusion in 11 (3.3%). 13 patients (3.9%) required a second procedure including 2 for post operative bleeding, 1 for a bladder neck disruption and 10 (3.0%) for transurethral resection of residual anterior tissue. ConclusionsWe demonstrate Aquablation to not only be safe but also providing durable outcomes at 4-years for men with BPH.

Antegrade ejaculation preservation in surgical treatment for benign prostatic hyperplasia: quest for balance between voiding and sexual function.

Surgical treatment of benign prostatic hyperplasia (BPH) carries a significant risk of ejaculation dysfunction. Preservation of antegrade ejaculation while providing effective, well tolerated, and durable treatment of BPH is a paramount component of physical and sexual well being for significant number of men. We reviewed available literature with an aim of providing status on antegrade ejaculation preserving BPH surgical therapies. Minimally invasive surgical therapies for BPH have been developed over the last decade, with significant marketing emphasis on their potential for preservation of antegrade ejaculation. However, the question about durability of relief of bladder outlet obstruction remains. Parallel to this technological development, the understanding of anatomical structures involved in ejaculation have resulted in technical modifications of well established surgical treatments modalities like transurethral resection of prostate, endoscopic enucleation of prostate and simple prostatectomy, thereby providing safe and durable relief of bladder outlet obstruction secondary to BPH with a satisfactory preservation of antegrade ejaculation. Preservation of antegrade ejaculation is an important goal for significant number of men needing BPH surgery. Novel minimally invasive surgical technologies have been developed for this purpose; but understanding of the anatomical structures essential for antegrade ejaculation have allowed technical modification of existing surgical techniques with excellent preservation of antegrade ejaculation.

New minimally invasive solutions for Benign Prostatic Obstruction (BPO) management: A position paper from the UrOP (Urologi Ospedalità Gestione Privata).

To the Editor, In recent years, alternative solutions have been proposed to obtain effective results comparable to TURP, which is currently considered the gold standard, and laser vapo-enucleation techniques (1, 2), but with the possibility of maintaining sexual functions. In recent years there has been a growing trend towards ejaculation preservation. Although the results of TURP (3), and most laser enucleation techniques are undoubted in the Benign Prostatic Hyperplasia (BPH) and Lower Urinary Tract Symptoms (LUTS) management, they often lack in the preservation of ejaculation. All the alternative recently proposed interventions (Rezum, AquaBeam, Urolift, TPLA, i-TIND, LEST) are procedures considered by some authors to be promising in both managing BPO and preserving sexual functions. However, all these methods are limited by a lack of long-term follow-up that would evaluate the efficacy over time, possible complications related to the method and the correct patient selection for a specific method. The aim of this letter is to summarize the available evidence and provide clinicians with practical recommendations on the use of the brand new minimally invasive techniques for the management of BPO. [...].

MP51-01 COMPARING THE TREATMENT OF PATIENTS WITH AQUABEAM® AND HOLEP FOR BENIGN PROSTATE HYPERPLASIA

You have accessJournal of UrologyCME1 Apr 2023MP51-01 COMPARING THE TREATMENT OF PATIENTS WITH AQUABEAM® AND HOLEP FOR BENIGN PROSTATE HYPERPLASIA Carlos Toribio-Vázquez, Ramon Cansino, Esaú Fernández-Pascual, Aritz Eguibar, Hector Ayllon, Pablo Solano-Heranz, Jose Ramon Perez-Carral, Juan Antonio Mainez, Alvaro Yebes, Andrea Rodriguez, Maria Alonso, and Luis Martinez-Piñeiro Carlos Toribio-VázquezCarlos Toribio-Vázquez More articles by this author , Ramon CansinoRamon Cansino More articles by this author , Esaú Fernández-PascualEsaú Fernández-Pascual More articles by this author , Aritz EguibarAritz Eguibar More articles by this author , Hector AyllonHector Ayllon More articles by this author , Pablo Solano-HeranzPablo Solano-Heranz More articles by this author , Jose Ramon Perez-CarralJose Ramon Perez-Carral More articles by this author , Juan Antonio MainezJuan Antonio Mainez More articles by this author , Alvaro YebesAlvaro Yebes More articles by this author , Andrea RodriguezAndrea Rodriguez More articles by this author , Maria AlonsoMaria Alonso More articles by this author , and Luis Martinez-PiñeiroLuis Martinez-Piñeiro More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.01AboutAbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic prostatic hydroablation (AquaBeam®) is a novel technique for the surgical treatment of benign prostatic hyperplasia (BPH). The objective of this study is to compare perioperative morbidity and treatment efficacy of prostatic hydroablation and Holmium laser prostate enucleation (HoLEP). METHODS: A total of 202 patients were analysed (101 by AquaBeam® and 101 by HoLEP) were analysed. A propensity score matching system was generated to obtain comparable cases from the HoLEP database at our institution. Patients included for analysis had undergone surgery in our department from April 2016 to October 2021. The following parameters where analysed: surgical time, haemoglobin (Hb) loss, length of stay, variation in Q-max, PSA, International Prostate Symptoms Score (IPSS), change in IPSS and in IPSS QoL, sexual function measured by the International Index of Erectile Function-5 item (IIEF-5), presence of ejaculation and perioperative morbidity. Median follow up was 12 months (IQR 12-36). RESULTS: Preoperative parameters were comparable between both groups (including prostate size, p=0.548). The perioperative and follow-up variables are shown in the following Table. No major differences in intraoperative complications were observed between both groups. With regards to postoperative complications, 17.3% vs 20.5% presented early urinary incontinence (AquaBeam® vs. HoLEP; p=0.62). 5 patients in the AquaBeam® group and 1 patient treated with HoLEP required blood transfusion (p=0.02). 2 patients treated with HoLEP and 5 with AquaBeam® required reoperation due to haematuria (p=0.03). 1 rectal perforation occurred and 1 patient died after a pneumonic process in the AquaBeam® group. CONCLUSIONS: Hydroablation surgery is an effective technique for patients with benign prostate hyperplasia. It offers good functional results whilst allowing the preservation of ejaculation. AquaBeam® presents a longer hospital admission mainly due to haematuria. The data presented compare our initial experience and learning curve with AquaBeam® with a well-established HoLEP technique in our department. Therefore, it must be regarded as preliminary. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e692 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Carlos Toribio-Vázquez More articles by this author Ramon Cansino More articles by this author Esaú Fernández-Pascual More articles by this author Aritz Eguibar More articles by this author Hector Ayllon More articles by this author Pablo Solano-Heranz More articles by this author Jose Ramon Perez-Carral More articles by this author Juan Antonio Mainez More articles by this author Alvaro Yebes More articles by this author Andrea Rodriguez More articles by this author Maria Alonso More articles by this author Luis Martinez-Piñeiro More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Ejaculatory Preserving Holmium Laser Enucleation of the Median Lobe: Preserving Sexual Function While Improving Urinary Outcomes

To evaluate perioperative outcomes related to sexual and urinary function in patients who underwent a holmium laser enucleation of the prostate (HoLEP) with selective laser enucleation of the median lobe. We retrospectively reviewed the first 450 HoLEP cases by a single surgeon from April 2019 to March 2022. Fifty-five patients with intravesical-prostatic protrusion or high bladder neck without obstructing lateral lobes underwent selective enucleation of the median lobe of the prostate. Patients were asked to comment on whether they had retrograde ejaculation during their follow-up appointment. Urinary function was assessed using the American Urological Association Symptom Score and subjective evaluation of urinary incontinence. Median age of the cohort was 65 years (range: 44-91). Compared to preoperative, there was significant improvement in mean postoperative American Urological Association Symptom Score (22.5 vs 6.9, P < .001), mean postoperative quality of life scores (4 vs 1.2, P < .001), and mean postoperative post void residual volumes (244.1 vs 69.3 cc, P < .001). No patients reported stress urinary incontinence. Of the 55 patients who underwent selective enucleation of the median lobe, 40 were sexually active. Of those men, 35 reported normal ejaculation, 3 had retrograde ejaculation that was unchanged from pre-op, and 2 had new ejaculatory dysfunction. In this case series of selective laser enucleation of the median lobe, urinary function significantly improved in short-term follow-up with preservation of ejaculation in approximately 90% of men.

Ejaculation Sparing Thulium Laser Enucleation of the Prostate: An Observational Prospective Study.

Benign prostatic hypertrophy (BPH) is a condition that appears with advancing age and affects 1/3 of men over 50 years, resulting in filling and emptying symptoms. One of the main limitations of endoscopic techniques for BPH is the occurrence of retrograde ejaculation. The purpose of this prospective observational study is to evaluate the efficacy and feasibility of ejaculation-sparing thulium laser enucleation of the prostate (ES-ThuLEP) in the treatment of BPH-related LUTS and the preservation of ejaculation. Sexually active patients with BPH were enrolled and followed up with at 3, 6, and 12 months after surgery. Personal and pharmacological histories were collected, while three standardized questionnaires-the International Index of Erectile Function short form (IIEF-5), the International Consultation on Incontinence Questionnaire for Male Sexual Matters Associated with Lower Urinary Tract Symptoms Module (ICIQ-MLUTSsex), and the International Prostatic Symptom Score (IPSS)-were administered. In addition, all patients underwent uroflowmetry and an assessment of post-void residual volume (PVR). A total of 53 patients were enrolled. A statistically significant improvement in the IPSS score, maximum flow (Qmax), and post-void volume (PVR) at 3 months, 6 months, and 12 months after surgery was found (p &lt; 0.05), while no statistically significant differences were reported between IIEF-5 scores before and after surgery. A total of 48 patients (88.6%) had preserved ejaculation at 3 months, while 92.4% and 94.3% of patients reported preserved ejaculation at 6 and 12 months, respectively. Nevertheless, some degree of hypoposia was referred, at 3, 6, and 12 months, by 43.7%, 30.6%, and 13.2% of patients, respectively. The ES-ThuLEP technique successfully preserved ejaculation in over 90% of patients, representing an ejaculation-sparing alternative in the treatment of BPH.

PD45-08 SELECTIVE MEDIAN LOBE LASER ENUCLEATION OF THE PROSTATE: PRESERVING SEXUAL FUNCTION WITHOUT COMPROMISING URINARY OUTCOMES

You have accessJournal of UrologyCME1 May 2022PD45-08 SELECTIVE MEDIAN LOBE LASER ENUCLEATION OF THE PROSTATE: PRESERVING SEXUAL FUNCTION WITHOUT COMPROMISING URINARY OUTCOMES Benjamin Press, David Kim, Eric Ghiraldi, Michael Siev, and Daniel Kellner Benjamin PressBenjamin Press More articles by this author , David KimDavid Kim More articles by this author , Eric GhiraldiEric Ghiraldi More articles by this author , Michael SievMichael Siev More articles by this author , and Daniel KellnerDaniel Kellner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002613.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Holmium laser enucleation of the prostate (HoLEP) is recommended for prostate glands of all sizes and is becoming a popular alternative to the transurethral resection of the prostate (TURP). Side effects of the procedure include stress incontinence, irritative lower urinary tract symptoms, and sexual function, most commonly retrograde ejaculation. We sought to evaluate perioperative outcomes related to sexual function and urinary function in patients who underwent selective laser enucleation of the prostate. METHODS: We conducted a retrospective review of the first 300 cases of HoLEP was performed from April 2019 – August 2021. Thirty-two patients within our cohort underwent selective enucleation of the median lobe of the prostate. Criteria for choosing to treat patients with selective enucleation were intravesical-prostatic protrusion or high bladder neck without obstructing lateral lobes. Patients were asked to comment on whether they had retrograde ejaculation during their follow up appointment. Urinary function was assessed using the American Urological Association Symptom Score (AUA-SS) and subjective evaluation of urinary incontinence. RESULTS: Mean age of our cohort was 65.9 years of age. Average peri-operative AUA-SS scores significantly improved (21.7 vs 6.8, p < 0.001). Average peri-operative quality of life scores significantly improved (4.1 vs 1.4, p < 0.001). Average peri-operative post void residual volumes were significantly improved (228.8 cc vs 45.7 cc, p = 0.001). No patients reported stress urinary incontinence. Of the 32 patients who underwent selective enucleation of the median lobe, 26 were sexually active. Of those men, 22 reported normal ejaculation, 2 men had retrograde ejaculation that was unchanged from pre-op. Data was missing for 2 men. CONCLUSIONS: In our case series of selective laser enucleation of the median lobe, urinary function significantly improved in short term follow-up with preservation of ejaculation in approximately 90% of men. A larger series is necessary with a longer follow up period to further investigate the durability of these findings. Further investigation is needed to define objective criteria to identify ideal candidates for selective median lobe enucleation. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e785 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benjamin Press More articles by this author David Kim More articles by this author Eric Ghiraldi More articles by this author Michael Siev More articles by this author Daniel Kellner More articles by this author Expand All Advertisement PDF DownloadLoading ...

Robotic retroperitoneal lymph node dissection for testicular cancer at a national referral centre.

ObjectivesWe aim to determine if robot‐assisted retroperitoneal lymph node dissection (R‐RPLND) can be performed as a safe option to open RPLND in selected patients with metastatic germ cell cancer.Patients and methodsThis population‐based prospective study was performed at a one of two national referral centres for RPLND in Sweden. All patients referred during January 2017–March 2021 were screened for possible inclusion. R‐RPLND was performed using the Da Vinci Xi surgical system. Perioperative parameters, postoperative complications (Clavien–Dindo), final pathology, preservation of antegrade ejaculation and relapse rates were evaluated. Classifiers for selecting patients to open versus robotic RPLND were analysed by logistic regression modelling. The median follow‐up was 23 months.ResultsOf 87 patients referred, 29 were selected for R‐RPLND, 19 in a post‐chemotherapy setting. In median, retroperitoneal tumour diameter was 18 mm, BMI 24 kg/m2, operative time 433 min, estimated blood loss 50 ml and length of stay 3 days. One patient underwent open conversion due to failure to progress. Four patients had Clavien–Dindo grade 3 complications, of which three were chylous‐related. No in‐field recurrences occurred during follow‐up.ConclusionThis population‐based study suggests that R‐RPLND can be safely performed in at least one third of patients referred for an RPLND. A relatively high rate of lymph‐leakage may represent a potential drawback. Tumour size may be the most important discriminator when deciding on robotic versus open RPLND. Further studies with longer follow‐up are needed to validate the results.

Does a 55-year-old Male with Lower Urinary Tract Symptoms and a 50-ml Gland Have To Decide Between Ejaculation and Voiding Function?

Treatment of lower urinary tract symptoms secondary to benign prostatic obstruction may affect ejaculatory function. However, preservation of ejaculation via minimally invasive surgical therapies might impair the long-term durability of voiding improvement.

Evaluation of a novel technique of bladder neck and supramontanal sparing ejaculatory preserving transurethral prostatectomy.

Transurethral resection of the prostate (TURP) can achieve highly satisfying symptomatic and functional outcomes but the loss of antegrade ejaculation represents a major reason for the avoidance of surgical treatment to preserve normal ejaculation and paternity. We present a novel technique to duplicate both bladder neck sparing and supramontanal sparing with resection of apical tissues to improve voiding and antegrade ejaculation. A prospective study done from June 2018 to June 2020 on 60 consecutive male patients with normal sexual activity diagnosed with benign prostatic enlargement. These patients were randomized into two groups; 30 patients in each group. Group 1 underwent bladder neck and supramontanal sparing ejaculatory preserving transurethral bipolar resection of prostate (ep-TUBRP) and Group 2 underwent classic transurethral bipolar resection of prostate (c-TUBRP). All patients were evaluated pre- and postoperatively (after 3months) using IPSS, Qmax and by IIEF-5. In both groups, there were significant improvements 3months postoperative in Qmax [7.97mL/s to 18.47mL/s (group A) and 7.8 to 20.7mL/s (group B)] and in micturition symptoms according to reductions in IPSS score [24 to 7.5 (group A) and 25 to 8.5 (group B)]. IIEF-5 score improved significantly from a mean of 12.9 to 18.6 (group A) and from 11.6 to 16.4 (group B). Antegrade ejaculation reported in 80% of patients in group A and 27% in group B which was significant (p < 0.001). Postoperative period did not reveal acute urinary retention, stress urinary incontinence, or serious adverse events. On short-term results, bladder neck and supramontanal ejaculation preserving transurethral bipolar resection of the prostate is superior to classic TURP in preservation of forward ejaculation with comparable efficacy in micturition parameters.

Preservation of antegrade ejaculation after surgical relief of benign prostatic obstruction is a valid endpoint

To review the current data on retrograde ejaculation (RE) and ejaculatory dysfunction (EjD) after endoscopic and minimally invasive surgical treatment of benign prostatic obstruction (BPO) and, their perceived impact in the quality of life (QoL) and sexual life of patients and their partners. Narrative review of systematic reviews (SR) assessing comparative rates of RE, EjD or erectile dysfunction (EF) was carried out. Relevant articles on the prevalence of RE, EjD or EF and on their impact in the QoL or sexual life of patients and partners were manually selected based on relevance. Twelve SRs reporting on comparisons of different endoscopic/minimally invasive treatments of BPO were found. Data on outcomes varied widely. Overall, after conventional TURP or laser techniques 42-75% of patients present RE. Prostatic incision and ablative procedures present lowest rates of de novo RE or EjD whereas laser adenomectomy and ejaculation preservation procedures preserve antegrade ejaculation in 46-68% of patients. EjDs is associated to LUTS and present in 10% of sexualy active men before intervention. It modulates the QoL and sexual life of the couple. In spite of the scarce literature assessing patient's and partner's perception of postoperative EjD, it strongly suggests that both parties value the maintenance of the ejaculatory function. Ejaculation-preserving techniques and minimally invasive techniques successfully prevent BPO treatment-induced RE or EjD in 70-100% of the cases. While this is appealing to patients and spouses, technique selection and treatment durability are issues to be discussed with the couple.

Ejaculation preserving HoLEP/TURP for benign prostatic hyperplasia: myth or reality

Objectives: To analyze whether technical modifications during transurethral resection of the prostate/holmium laser enucleation of the prostate results in preservation of antegrade ejaculation, at the same time providing effective relief from bladder outlet obstruction. Materials and methods: A total of 119 patients with benign prostatic hyperplasia were included in the study carried out at our center between March 2016 and December 2018. The patients were divided into two groups, with 56 (47.06%) patients in the ejaculation-preserving transurethral resection of the prostate group and 63 (52.94%) patients in the ejaculation-preserving holmium laser enucleation of the prostate group. The patients in the two groups were assessed with respect to age, prostate size, serum prostate-specific antigen and any comorbidity. The parameters assessed pre and postoperatively include Qmax, international prostate symptom score, peripheral vascular resistance, overall sexual satisfaction and overall ejaculation. All patients were regularly followed up during the study period and were included in the final analysis. Results: The mean (standard deviation) age, prostate size, serum prostate-specific antigen of patients who underwent ejaculation-preserving transurethral resection of the prostate and patients who underwent ejaculation-preserving holmium laser enucleation of the prostate was 61.67 (5.26)/61.48 (5.40) years, 59.75 (10.61) ml/74.44 (20.27) ml, 2.38 (0.77) ng/ml/2.47 (0.83) ng/ml, respectively. Postoperatively there was a statistically significant improvement in Qmax, international prostate symptom score and peripheral vascular resistance in both groups. The overall sexual satisfaction after surgery improved significantly in the ejaculation-preserving transurethral resection of the prostate group; however, it deteriorated significantly in the ejaculation-preserving holmium laser enucleation of the prostate group, which was statistically significant at 6 months. After treatment, the overall ejaculation assessed by asking question 9 of the international index of erectile function 15 questionnaire was unchanged in patients from the ejaculation-preserving transurethral resection of the prostate group and deteriorated in the ejaculation-preserving holmium laser enucleation of the prostate group and the difference between the two groups was statistically significant. Conclusion: An ejaculation preserving technique seems to be more feasible in small prostate glands when appreciable apical tissue is spared. However, holmium laser enucleation of the prostate is basically a size-independent procedure and enables the complete removal of the adenoma tissue like an open prostatectomy. To compromise the extent of tissue removal or candidate selection for a better ejaculation preservation outcome might damage the indigenous value of the holmium laser enucleation of the prostate. To conclude, if the preservation of sexual satisfaction and ejaculatory function is a priority, patients should be offered ejaculation-preserving transurethral resection of the prostate as the treatment of choice over ejaculation-preserving holmium laser enucleation of the prostate.

Sophisticated surgical management of distinctive patients with benign prostatic hyperplasia (BPH)

Herein we describe four clinical scenarios. For the standard patient (prostate volume 30-80 ml, life expectancy >10 years) transurethral resection of the prostate (TURP) remains the standard of care, while endoscopic enucleation is avaluable alternative. Patients with arelevant middle lobe profit most from TURP, endourological enucleation procedures, or laser vaporization. In the case of the absence or amoderate-sized middle lobe and the absence of severe bladder outlet obstruction (BOO), minimally invasive procedures such as Rezūm®, UroLift® or prostate artery embolization (PAE) can be offered. Patients have to be informed that long-term data on this specific indication are lacking. Particularly younger men requiring BPH surgery are interested in preserving ejaculatory function. In the presence of severe BOO, ejaculatory-protective TURP or endoscopic enucleation by preserving the pericollicular region or aquablation are the methods of choice providing an antegrade ejaculation in 60-90% of cases. Rezūm®, AquaBeam®, and UroLift® enable preservation of ejaculation in almost 100%; data on PAE with this respect are more controversial. For patients with asmall prostate and significant post void residual, athorough preoperative work-up, including urodynamics and bladder/detrusor wall thickness measurement, is of great importance. Desobstructive surgery provides satisfactory short- and midterm outcome, yet the long-term outcome is disappointing and remains to be determined in greater detail. The broad spectrum of therapeutic options enables today an individualized minimally invasive or surgical management of BPH considering patient wishes, anatomical factors or urodynamic factors. The time of a"one therapy fits all" strategy is definitely history.

Interventional therapy in benign conditions of the prostate.

Interventional therapies (IT) are increasingly popular treatment options for benign prostatic hyperplasia (BPH). IT aim to reduce morbidity and side effects related to invasive surgical procedures. To date, IT are considered experimental, though they are evolving rapidly and starting to challenge established surgical strategies. With gradually increasing evidence for the benefits of IT in BPH, several techniques are moving out of the realm of research and into everyday clinical practice. As such, IT provides encouraging mid-term functional outcomes with improved health-related quality of life (QoL), particularly in terms of better preservation of ejaculation. The distinct role IT could play as abridge between exhausted drug-based treatment options and surgery is yet to be defined. Further studies are required before IT can be recommended as alternatives to invasive therapies. Systematic trials are needed to identify subgroups of patients who can benefit particularly from IT in comparison to other treatments, to identify features of the prostate particularly suited to aspecific IT, and to analyze the durability of success for each technique.

Transurethral anatomical enucleation of the prostate with Tm:YAG support (ThuLEP): Evolution and variations of the technique. The inventors' perspective.

After its introduction, transurethral anatomical enucleation of the prostate with Tm:YAG support (ThuLEP) has evolved as one of the standard techniques of transurethral anatomical endoscopic enucleations of the prostate. Growing evidence has proven ThuLEP as an alternative for the treatment of bladder outlet obstruction caused by benign prostatic enlargement and has been acknowledged by the EAU Guidelines on Management of Non-Neurogenic Male Lower Urinary Tract Symptoms, incl. Benign Prostatic Obstruction. The uniqueness of ThuLEP as a concept made it a blueprint for other laser and nonlaser enucleating techniques based on the emphasis on two principles: widely blunt anatomical dissection and demystification of energy sources as being secondary for transurethral enucleation. The original technique has been technically refined by the inventor and other working groups in the field. The evolutionary modifications followed the academic discourse on anatomical enucleation for measures to prevent early postoperative stress urinary incontinence and preservation of antegrade ejaculation. Variations of the original three-lobe dissection technique were introduced with two-lobe approach or en bloc dissection. The manuscript is accompanied by an instructional video and surgical atlas on the currently most commonly applied two-lobe technique.

AUTHOR REPLY

We agree that preservation of ejaculation is viewed positively by patients and their partners. For many men, this factor alone helps them determine which of the myriad therapies for benign prostatic hyperplasia they ultimately select. Dr. Ulchaker is spot on with his observation that many benign prostatic hyperplasia therapies can result in ejaculatory dysfunction with varying rates among medical, minimally invasive technologies and surgery. However, we maintain that preservation of tissue near and around the verumontanum is key to ensuing ejaculatory preservation. Although some alpha blockers may result in ejaculatory dysfunction, this is more likely secondary to anejaculation rather than retrograde ejaculation. Furthermore, Rezum water vapor therapy does not eliminate tissue near the veru as in a resection and/or vaporization technique. Rather, it creates pockets of coagulation necrosis. Finally, and of interest, the Aquablation technique by choice and design attempts to preserve ejaculation by modifying treatment patterns near the veru. We believe that maintenance of ejaculation will be less likely related to which technology is used and more due to tissue preservation near the verumontanum. Time will tell!

Preservation of Ejaculatory Function After Postchemotherapy Retroperitoneal Lymph Node Dissection (PC-RPLND) in Patients With Testicular Cancer: Template vs. Bilateral Resection

Background: Post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) plays a crucial role in treatment of metastatic non-seminomatous germ cell cancer.Objective: To evaluate the functional outcome regarding the preservation of ejaculatory function comparing a bilateral vs. unilateral template resection in PC-RPLND patients. In addition, oncological safety and perioperative complications of the unilateral template resection was compared to the full bilateral one.Design/Setting/Participants: Between 2003 and 2018, 504 RPLNDs have been performed in 434 patients. The database of consecutive patients was queried to identify 171 patients with PC-RPLND after 1st line chemotherapy for a non-seminoma with or without bilateral template resection. Re-Do's, late relapse, salvage patients, and thoraco-abdominal approaches were excluded. Indication for a template resection was a unilateral residual mass mainly <5 cm as published (1).Outcome, Measurement, and Statistical Analysis: Descriptive statistics were used to report preoperative features, postoperative outcomes and patterns of recurrence, on the overall population and after stratification for the type of resection (bilateral vs. unilateral). Kaplan-Meier analyses were used to describe recurrence- and cancer-specific mortality-free survival rates at different time points.Results and Limitations: Overall, 90 and 81 patients underwent unilateral and bilateral radical resection, respectively. Median size of residual mass was 7 cm for bilateral and 4 cm for unilateral template resection. Clinical stage II and III were present in 31 and 69% of patients, respectively. Median follow-up was 14.5 months (IQR 3.3–37.6). The 1- and 2-year recurrence-free survival rates were 91 and 91%, and 77 and 72% for patients treated with unilateral template and bilateral resection, respectively (p = 0.0078). Median time to recurrence was 9.5 and 9 months in template and bilateral resection group, respectively.Adjunctive procedures were performed in 56 patients (33%) and were significantly more frequent in the bilateral resection group (43 vs. 23%, p = 0.006). The overall high-grade complication rate (Clavien-Dindo ≥ III) was 6, 3, and 9% in unilateral template and bilateral resection group, respectively (p = 0.6). The rate of preservation of antegrade ejaculation was significantly higher in the unilateral group.Conclusions: Antegrade ejaculation in patients undergoing unilateral template resection with a residual mass <5 cm can be preserved at a much higher rate. Moreover, this surgical procedure is oncologically safe in terms of mid-term recurrence and CSM-free survival rates. This data undermines the growing evidence of limited PC-RPLND being justifiable in strictly unilateral residual mass <5 cm. This data has to be confirmed with a longer follow-up regarding in-field and retroperitoneal recurrences.

MP62-03 EJACULATION-PRESERVING GREENLIGHT PHOTOVAPORIZATION: SHORT- AND LONG TERM RESULTS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I1 Apr 2018MP62-03 EJACULATION-PRESERVING GREENLIGHT PHOTOVAPORIZATION: SHORT- AND LONG TERM RESULTS Steeve DOIZI and Bertrand LUKACS Steeve DOIZISteeve DOIZI More articles by this author and Bertrand LUKACSBertrand LUKACS More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2004AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Loss of antegrade ejaculation is a risk with benign prostatic obstruction relief surgery whatever the technique used. The aim of this study was to determine the short- and long-term preservation of antegrade ejaculation and functional results with ejaculation-preserving Greenlight photovaporization. METHODS All consecutive patients with LUTS and sexually active scheduled for BPO relief surgery in a tertiary reference center were included in this prospective evaluation between January 2010 and December 2013. All patients were offered a surgical treatment with preservation of the ejaculatory function and were informed of the risk of failure and early recurrence of LUTS with the need of medication or surgery. Endpoints were change in objective (uroflowmetry, postvoid residual [PVR]), and subjective (International Prostate Symptoms Score [IPSS], Life Quality Index [LQI]; Danish prostate symptom score sex questionnaire (DAN-PSSsex). Evaluation was performed at 1-3, 3-6, 6-12, 12-24, 24-36, >36 months. RESULTS Overall, 65 patients with mean age of 62.15 years were included. Antegrade ejaculation was preserved in 59 of 65 (90.7%) patients at 1-3 months (Table 1). This rate remained constant until 24-36 months. Significant improvements in maximum flow rate, micturition volume, and PVR were observed at 3 months. Micturition symptoms, as measured by IPSS and LQI, were also significantly reduced. Improvements were maintained up to 36 months (Table 2). No serious adverse events were reported. Seven (10.8%) patients received a second ejaculation-preserving Greenlight photovaporization due to recurrence in symptoms. CONCLUSIONS Antegrade ejaculation was preserved with the use of ejaculation-preserving Greenlight photovaporization with excellent outcome. Observed symptomatic and functional outcomes were comparable with conventional TURP. The results from this study underline the necessity of reviewing the old concept of ejaculation physiology. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e832-e833 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Steeve DOIZI More articles by this author Bertrand LUKACS More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The Long-term Effect of Superficial Bladder Neck Incision on Ejaculation and Incontinence in Boys with Primary and Secondary Bladder Neck Obstruction.

Superficial bladder neck incision (SBNI) is controversial at young age, with retrograde ejaculation after puberty as main concern. The aim of the study is to investigate the long-term effect of SBNI on ejaculation and incontinence in boys with primary and secondary bladder neck obstruction (BNO). In boys with infravesical obstruction, SBNI was performed in case of a persistent BNO after earlier desobstruction or in case of primary severely obstructive bladder neck. SBNI was performed with a diathermy hook, always superficially (2-3 mm) and unilaterally at 7 O'clock. Males that had SBNI during childhood after posterior urethral valve incision or relief of other obstruction between 1986 and 2003 were included. Evaluation was done by International Continence Society male sex questionnaire, International Prostate Symptom Score, developmental International Consultation Modular Questionnaire on Urinary Incontinence, frequency volume chart, and uroflowmetry. Of 79 traceable patients, 40 (50.6%) participated. Of these, 37 (92.5%) completed all questionnaires and 28 (70%) performed uroflowmetry. Median age at SBNI was 4.7 years [interquartile range (IQR) 0.6-8.5] and was 19.6 years (IQR 17.3-20.9) at follow-up. All men had antegrade ejaculation, 4/37 (10.8%) reported possibly reduced ejaculatory volume. Eight (22%) had moderate lower urinary tract symptoms and two (5.4%) had moderate incontinence. Median maximum flow rate was 30.1 mL/s (IQR 24.4-42.6). SBNI in boys with severe infravesical obstruction can be done safely with preservation of antegrade ejaculation and no additional lower urinary tract dysfunction.

1078 Combined urethral lift and resection of the prostate (CURP): A novel surgical treatment of LUTS secondary to benign prostatic enlargement with preservation of antegrade ejaculation

1078 Combined urethral lift and resection of the prostate (CURP): A novel surgical treatment of LUTS secondary to benign prostatic enlargement with preservation of antegrade ejaculation