Ejaculation-sparing enucleation of benign prostate hyperplasia: is it almost feasible?

Benign prostatic hyperplasia (BPH) is a highly prevalent condition in older men, often associated with both lower urinary tract symptoms (LUTS) and reduced quality of sexual life. During the past three decades, researchers have focused on improving new operative techniques to reduce complications of traditional surgery for BPH, such as urethral stricture, stress urinary incontinence. Surgeons have increased interest in investigating the relationship between surgical treatment and postoperative sexual dysfunction such as erectile and ejaculatory dysfunction, as the demand to minimise adverse events has become a concern for more patients. In view of the above, this paper aims to systematise information on the quality of sexual life of patients after surgical treatment of BPH. This work has shown that this problem remains topical to nowadays. It is noteworthy that only a limited number of well-designed, randomised studies exist on this issue. This is mainly due to the unavailability of a uniform methodology for assessing sexual function in surgically treated BPH-patients.

Effect of endoscopic enucleation of the prostate on erectile and ejaculatory function

Kotov,

Semenov,

Yusufov

et al. 2023

Laser technologies in surgery for benign prostate hyperplasia

Rakhimov,

Feofilov,

Arbuzov

2024

Introduction. Benign prostatic hyperplasia (BPH) is a multifactorial and widespread problem of modern medicine, which has not only medical but also social significance. The presence of lower urinary tract symptoms (LUTS) in men has a negative impact on the quality of life. One of the modern surgical methods for treating BPH is the use of laser technologies.Objective. To compare the effectiveness and safety of laser technologies using the example of the use of diode and thulium lasers in BPH surgery.Materials & methods. The study included 89 men with BPH who underwent surgery from 2020 to 2022. Patients were divided into two groups: in group 1 (n = 37) photoselective vaporization of the prostate was performed using a Diode Laser Vaporization of the Prostate (DiVAP), in group 2 (n = 52) - Thulium Laser Enucleation of the Prostate (ThuLEP). To assess the results of treatment, we studied indicators of maximum urine flow, residual urine volume, prostate volume, prostate-specific antigen level, severity of LUTS (IPSS scale) and symptoms of erectile dysfunction (IIEF-5 scale), level of quality of life (QoL index) and the frequency of postoperative complications. The outcomes were assessed at baseline and 3, 6, 12 months after the procedure. The duration of the operation, the duration of catheterization and the length of stay of patients in the hospital were also recorded.Results. At a long-term follow-up (12 months), the effectiveness of DiVAP and ThuLEP was comparable in terms of prostate volume (24.0 and 24.3 cm3), PSA level (3.3 and 3.4 ng/ml) and quality of life of patients related to urination (2.3 and 2.0 points). The severity of LUTS one year after treatment was also comparable in the groups (4.1 and 4.6 points), however, the IPSS scale scores was more favorable in the ThuLEP group at three- and six-month follow-up points (3 months: 14.9 and 10.0 points; 6 months: 9.3 and 7.5 points). At the same time, ThuLEP also turned out to be more effective in the rate of maximum urine flow achieved after a year (15.2 and 25.8 ml/s), the residual urine volume (8.2 and 2.2 ml), and IIEF-5 questionnaire score (22, 4 and 24.4 points), DiVAP - by operation time (58.5 and 84.6 minutes) and catheterization duration (26.8 and 32.5 hours). There were no statistically significant differences in the duration of hospitalization (2.2 and 2.1 days). Postoperative complications are recorded 2 times more often with DiVAP than after ThuLEP.Conclusions. The study confirmed the high efficiency of endoscopic laser enucleation (ThuLEP) and laser vaporization (DiVAP) technologies. The safety of ThuLEP is due to the lower incidence of postoperative complications compared to DiVAP. The success of laser operations directly depends on careful selection of patients, as well as the experience of the surgeon.

Effect of benign prostatic hyperplasia surgery on ejaculatory function

Dianov,

Kyzlasov,

Martov

et al. 2024

Self Cite

Introduction. There are a wide range of techniques available for the removal of hyperplastic prostate tissue. However, the choice of method rarely considers its eﬀect on ejaculatory function.Objectives. To evaluate the eﬀect of surgery for benign prostatic hyperplasia (BPH) by endovideosurgical posterior adenomectomy (EVS AE) and transurethral electroenucleation of the prostate (TUEB) on copulatory function and its ejaculatory component.Materials & methods. Sixty sexually active patients aged 58 to 78 years with indications for surgical treatment of BPH were included in the study. The patients were randomized into two equal groups. The ﬁrst group (30 patients) underwent EVS AE by standard technique without preservation of the prostatic urethra. The second group (30 patients) underwent TUEB. Before treatment, standard questionnaires used in urologic practice were completed: IIEF-5, IPSS-QOL, and the scale of quantitative assessment of male copulatory function (scale “MCF”). The block of questions speciﬁcally characterizing the ejaculatory component and the "Male Sexual Health Questionnaire", namely the section " Ejaculatory function domain", were analyzed separately. The assessment was conducted before treatment and at the 12th week following surgery. No signiﬁcant diﬀerences were found between the groups on any of the questionnaires prior to surgery.Results. Three months following surgery, there was a signiﬁcant improvement in the IPSS-QOL scores for the EVS AE group, by 24 points and 4.3, respectively, and for the TUEB group, 25.6 points and 4.3 (both p < 0.0001). No change was observed in the IIEF-5 questionnaire (p > 0.05). A slight reduction in scores was noted on the MCF scale for the TUEB group (by 2.9 points, p < 0.05), indicating that the general state of erectile function remained unchanged. However, reductions were seen in the "MCF — Ejaculatory Component" and "Male Sexual Health Questionnaire — Ejaculatory function domain" scales for the TUEB group, with ballpark scores decreasing by 3.2 and 6.8 points, respectively (both p = 0.0326 and p = 0.0254), indicating a worsening in ejaculatory function following TUEB treatment.Conclusion. When selecting a speciﬁc surgical approach for BPH management, consideration should be given to the patient's tolerance for the degree of invasiveness of the procedure while preserving ejaculatory function, and adherence to a treatment strategy that aligns with the patient's individual preferences and expectations.