Ejaculatory dysfunction in the treatment of lower urinary tract symptoms

Abstract

The link between lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) and sexual dysfunction is well established. Sexual dysfunction can encompass both ejaculatory dysfunction (EjD) and erectile dysfunction (ED). Ejaculatory dysfunction can consist of premature ejaculation, delayed ejaculation, retrograde ejaculation, anejaculation, decreased force of ejaculation and pain upon ejaculation. The impact of different medical and surgical therapies on ejaculatory function will be reviewed. We reviewed the various categories of LUTS treatment including the canonical epidemiology and pathophysiology as well as the surgical and medical treatments for LUTS/BPH. We note that most surgeries and several medical treatments have a certain but ill-defined negative impact on ejaculatory function. Several MISTs and selected medical therapies appear to have little impact on EjD. Both EjD and BPH are very common disorders in men under the care of an urologist. It is well documented that there is a clinical association between these two entities. Unfortunately many of the medical treatments and almost all surgical treatment impact the ejaculatory function of the patient. The surgical treatment of BPH often leads to retrograde ejaculation while medical treatment leads to anejaculation.

Minimizing Sexual Dysfunction in BPH Surgery

“…Utilizing light wavelengths of 532 nm, which is preferentially absorbed by hemoglobin, the GreenLight laser has emerged as an alternative therapy to TURP for the treatment of BPH via rapid vaporization of the transitional zone of the prostate [26, 43•]. Results from the GOLIATH prospective trial comparing GreenLight photoselective vaporization of the prostate (PVP) to TURP showed no significant difference between rates of REj and IIEF-5 scores between the two procedures at the 1-and 2-year follow-ups, respectively [44, 45].…”

Transüretral prostat rezeksiyonu sonrası gelişen retrograd ejakülasyon işlem öncesinde öngörülebilir mi?

“…Ejakülatın retrograd olarak mesaneye akışına, patolojik olarak açık olan internal vezikal sfinkter ya da mesane boynu izin verir. [4] Fakat, klinik, fizyolojik ve anatomik bulguların bazıları bunun böyle olmayabileceğini göstermiştir. Videoürodinamik çalışmalar ise, persistan olarak açık mesane boynu olan hastaların antegrad ejakülasyona sahip olabildiğini ortaya koymuştur.…”

“…[2] Retrograd ejakülasyon seksüel fonksiyon üzerindeki etkisi yanında genel yaşam kalitesi ile de ilişkilidir. TUR-P sonrası retrograd ejakülasyon sıklığı seriler arasında çeşitlilik göstermekle beraber %47,8 [3] ve %65 [4] gibi farklı oranlar verilmiştir.…”

“…[6] Mesane boynu/çıkımında düzensiz nitrik oksit sentetaz (NOS) uyarımı ve düz kas gevşemesine neden olan endotelyal disfonksiyon, retrograd ejakülasyon gelişimde rol oynayabilir. [4] Önceleri TUR-P ve transvezikal prostat adenomiyomektomi operasyonu sonrasında anterograd ejakülasyonun kaybolması mesane boynunun ve buradaki düz kas sfinkterinin ortadan kaldırılmasına atfedilirken, daha sonra yapılan dinamik transrektal ultrasonografi çalışmaları ile operasyon sonrası antegrad ejakülasyonun devamı için yeterli supramontanal dokunun gerekli olduğu bildirilmiştir. Bu supramontanal doku ile prostat kapsülünün, emisyon fazında kontrakte olarak seminal sıvının mesaneye ulaşmasını engellediğini düşündürmüştür.…”

Significant relationship between parameters measured by transrectal color Doppler ultrasound and sexual dysfunction in patients with BPH 12 months after TURP

“…A link between sexual dysfunction and lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) has been reported [ 1 ]. Sexual dysfunction includes erectile dysfunction (ED) and ejaculatory dysfunction, and ejaculatory dysfunction includes premature ejaculation, retrograde ejaculation, delayed ejaculation, painful ejaculation, and decreased force of ejaculation [ 1 ]. Transurethral resection of the prostate (TURP) remains the standard treatment for symptomatic BPH, which occurs in about 10% to 20% of men over 40 years of age [ 2 – 4 ].…”