Assessment of copulative function and severity of lower urinary tract symptoms in patients with benign prostatic hyperplasia after transurethral enucleation

Abstract

AIM: was to conduct a comparative assessment of copulative function and the severity of lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH) who underwent laser and bipolar transurethral enucleation of the prostate and who treated conservatively.
 MATERIALS AND METHODS: 143 BPH patients aged 50 to 80 years (mean age 65 years) with complaints of copulatory and urinary disorders were under observation. All patients were divided into two groups. The 1st (main) group included 102 patients who underwent surgical treatment: transurethral laser enucleation of the prostate (n = 55) and transurethral bipolar enucleation of the prostate (n = 47). Patients of the 2nd group (n = 41) received conservative treatment. Control examinations were performed before treatment, 4, 12 and 24 weeks after it.
 RESULTS: All 102 patients of group 1, regardless of the type of surgery, noted retrograde ejaculation four weeks after surgery. In the majority of patients of the 1st group during these periods weakening of orgasm was noted, in a significant number deterioration of erection and decreased libido were noted. Upon further observation, by the 12th week after the operation, restoration of all components of the copulatory function was noted, with the exception of ejaculation. By the 24th week of observation, only in 2 patients of the 1st group the normal mechanism of ejaculation was restored. Surgical treatment of patients in group 1, regardless of the method of surgery, led to a significant decrease in the severity of LUTS, an increase in the maximum urine flow rate, a decrease in the volume of the prostate gland and the amount of residual urine. There were no significant differences in the dynamics of these indicators depending on the method of transurethral enucleation. The patients of the 2nd group also had an improvement in clinical parameters, but it was much less pronounced than in the 1st group.
 CONCLUSION: Laser and bipolar transurethral enucleation of the prostate are effective surgical techniques that significantly improve the outflow of urine from the bladder, reduce the severity of LUTS and improve the sexual function of patients. Surgery is well tolerated by patients. At the same time, almost all patients operated on by these methods develop retrograde ejaculation.

Thulium laser enucleation of prostate (ThuLEP): efficacy and safety evaluation in patients with a prostate volume more than 80 cm3

“…Длительное время золотым стандартом лечения ДГПЖ считается монополярная трансуретральная резекция простаты, однако при ее выполнении при объеме предстательной железы более 80 см 3 увеличивается риск развития осложнений [5]. Для хирургического лечения ДГПЖ больших размеров были предложены и успешно применяются биполярная плазмокинетическая трансуретральная резекция, электровапоризация, лазерная гольмиевая и тулиевая энуклеация, лапароскопическая и робот-ассистированная аденомэктомия [4,[8][9][10]. Все эти методы лечения используются в урологической практике, однако каждый из них имеет свои преимущества и недостатки.…”