Retrograde ejaculation after holmium laser enucleation of the prostate (HoLEP)—Impact on sexual function and evaluation of patient bother using validated questionnaires

Abstract

Background A vast body of literature has focused on erectile function after Holmium Laser Enucleation of the Prostate (HoLEP). Interestingly, retrograde ejaculation (RE), despite its frequency has sparsely been investigated. Objectives To study patient perception and impact of RE on sexuality following HoLEP. Materials and methods We retrospectively analyzed 2,131 patients undergoing HoLEP 2006‐2015 at our institution. Patients were followed via standardized questionnaires namely International Index of Erectile Function (IIEF) as well as Male Sexual Health Questionnaire Ejaculatory Short Form (MSHQ‐EjD‐SF). Exclusion criteria were missing/follow‐up <6 months, missing data on MSHQ‐EjD‐SF and IIEF score, resulting in 535 assessable patients. Multivariable logistic regression was employed to identify independent predictors of satisfaction with overall sex life (IIEF question 13). Results Median follow‐up was 50 months (IQR: 30‐78). Overall, 495 (92.5%) patients reported RE. Patients differed significantly with respect to age (P = .036), IPSS at follow‐up (P = .01), and erectile function (P < .001), whereas no other statistically significant differences were observed. In multivariable logistic regression analyses, presence of RE was not independently associated with satisfaction with overall sex life (OR: 2.7, 95% CI: 0.70‐10.5, P = .1). However, in the cohort of patients exhibiting RE, patients who stated “feeling bothered by RE” had lower satisfaction with overall sex life (OR: 0.23, 95% CI: 0.13‐0.38, P < .001). Bother by RE varied according to erectile function and did not impact overall satisfaction in men with superior erectile function. Conclusions RE is a very common event after HoLEP but in this retrospective analysis was not associated with overall satisfaction with sex life. Contrary, satisfaction with sex life is impaired in patients who feel bothered by RE. Proper patient selection will pose key to identify patients in which RE bother will offset the benefits of LUTS relief.

Plasma Kinetic Enucleation vs Holmium Laser Enucleation for Treating Benign Prostatic Hyperplasia: A Randomized Controlled Trial with a 3-Year Follow-Up

“…[22][23][24] Retrograde ejaculation is another main adverse event that has been reported to occur in as much as 86.2% of patients after HoLEP and in about a half of patients after PKEP. 25,26 In this study, we also observed high retrograde ejaculation rates; however, these were lower than those reported in previous studies. It is possible that inconsistencies in low rates were attributable to the fact that patients without sexual life were regarded as having no retrograde ejaculation during the follow-up period.…”

Comparison of Contemporary Surgical Outcomes Between Holmium Laser Enucleation of the Prostate and Robotic-Assisted Simple Prostatectomy

“…The pathophysiology of this surgical outcome is likely due to the removal of periverumontanal prostatic tissue [22]. Gild et al [23] studied the effects of HoLEP in a retrospective review of 2131 patients who underwent surgery between 2006 and 2015. At a median follow-up of 50 months, 92.5% of patients reported RE.…”

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

“…S. Alloussi показал, что для сохранения естественной эякуляции большее значение имеет сохранение тканей в области семенного бугорка, чем резекция тканей в области шейки [2]. В качестве критериев для возможности прогнозирования сохранения эякуляторной функции автор метода указывает объём простаты до 50 см 3 и отсутствие средней доли.…”

“…Внедрение в клиническую практику электрохирургической и лазерной энуклеации привело к постепенному снижению применения трансуретральной резекции простаты, что связано с меньшей частотой развития геморрагических осложнений и послеоперационных рецидивов после энуклеации [1,3,4].…”

“…Несмотря на информированность о высокой вероятности нарушения эякуляции, большая когорта пациентов заинтересована в её сохранении, поэтому для каждого из способов удаления аденоматозных тканей (инцизия, вапоризация, резекция и энуклеация) продолжается активное развитие эякуляторно-протективных методик, например, эякуляторно-протективной вапоризации, а также продолжается активный поиск и внедрение в практику новых малоинвазивных методов (Urolift®, водоструйная аблация) [3,4].…”