madman
Super Moderator
Abstract
Purpose of Review To explore the sexual outcomes following the novel minimally invasive surgical procedures for benign prostatic hyperplasia- (BPH-) related lower urinary tract symptoms (LUTS), with an emphasis on ejaculatory dysfunction (EjD).
Recent Findings A database search with a 10-year time restriction was carried out until February 20, 2020, using MEDLINE through the PubMed Platform evaluating minimally invasive treatment modalities for BPH and their effect on EjD. After the article selection, we retrieved data for men randomized in 19 different studies with results in 40 separate published articles investigating minimally invasive BPH surgery and reporting EjD rates. To date, water vapor thermal therapy or Rezūm, prostatic urethral lift (PUL) or UroLift®, prostate artery embolization (PAE), and Aquablation showed acceptable rates (< 2%) of retrograde ejaculation by 1 year and had very low adverse events related to the procedure. Both PUL and Rezūm demonstrated lower rates when compared with PAE and Aquablation.
Summary With comparable sexual side effect profiles postoperatively, clinicians may determine which therapeutic modality is optimal for patients based on efficacy and cost-benefit. Further randomized clinical trials are required to directly compare the effect of novel minimally invasive surgical procedures for BPH-related LUTS on ejaculation and sexual function.
Introduction
Benign prostatic hyperplasia (BPH) is a benign proliferation of the tissue in the transition zone of the prostate. The prevalence of BPH increases with age with autopsy studies showing histological prevalences of 8, 50, and 80% in the fourth, sixth, and ninth decades of life, respectively [1, 2]. The gold standard treatment of BPH is the transurethral resection of the prostate (TURP). Unfortunately, men who undergo TURP have considerable sexual dysfunction, including retrograde ejaculation (RE). Up to 66.1% of men who undergo TURP report RE [3]. RE will also affect three out of four men treated with Holmium laser enucleation of the prostate (HoLeP) [4].
In the last several decades, multiple treatments have been introduced for the treatment of BPH to not only treat lower urinary tract symptoms (LUTS) (Fig. 1) but also have potentially fewer sexual side effects. RE occurs when the sphincter of the bladder neck fails to contract to cause the semen to reflux into the urinary bladder. RE often occurs after BPH treatments which do not preserve or affect the bladder neck. This may be avoided in treatments that do not directly affect the bladder neck, such as novel minimally invasive techniques.
With a modern emphasis on improved quality of life in patients suffering from BPH, there has been an impetus to develop ejaculatory-preserving minimally invasive techniques. The present systematic review aimed to explore the sexual side effects of these novel minimally invasive surgical procedures for BPH-related LUTS, with an emphasis on EjD
Surgical Treatments
*Water Vapor Thermal Therapy
*Prostatic Urethral Lift
*Prostate Artery Embolization
*Aquablation
Conclusions
The systematic review of novel modalities for BPH-related LUTS revealed improved post-operative ejaculation metrics compared to traditional treatment. The water vapor thermal therapy of Rezūm, PUL or UroLift®, PAE, and Aquablation showed acceptable rates of RE and had very low adverse events related to the procedure. Ultimately, all four treatment modalities are comparable in terms of sexual side effects, with clinical trials of Rezūm, PUL, and PAE showing minimal to no RE events postoperatively. PUL and Rezum both demonstrated lower rates of ejaculatory dysfunction while preserving MSHQ-EjD scores when compared to PAE and Aquablation. Further research is required to directly compare these treatment modalities in a randomized clinical trial.
Purpose of Review To explore the sexual outcomes following the novel minimally invasive surgical procedures for benign prostatic hyperplasia- (BPH-) related lower urinary tract symptoms (LUTS), with an emphasis on ejaculatory dysfunction (EjD).
Recent Findings A database search with a 10-year time restriction was carried out until February 20, 2020, using MEDLINE through the PubMed Platform evaluating minimally invasive treatment modalities for BPH and their effect on EjD. After the article selection, we retrieved data for men randomized in 19 different studies with results in 40 separate published articles investigating minimally invasive BPH surgery and reporting EjD rates. To date, water vapor thermal therapy or Rezūm, prostatic urethral lift (PUL) or UroLift®, prostate artery embolization (PAE), and Aquablation showed acceptable rates (< 2%) of retrograde ejaculation by 1 year and had very low adverse events related to the procedure. Both PUL and Rezūm demonstrated lower rates when compared with PAE and Aquablation.
Summary With comparable sexual side effect profiles postoperatively, clinicians may determine which therapeutic modality is optimal for patients based on efficacy and cost-benefit. Further randomized clinical trials are required to directly compare the effect of novel minimally invasive surgical procedures for BPH-related LUTS on ejaculation and sexual function.
Introduction
Benign prostatic hyperplasia (BPH) is a benign proliferation of the tissue in the transition zone of the prostate. The prevalence of BPH increases with age with autopsy studies showing histological prevalences of 8, 50, and 80% in the fourth, sixth, and ninth decades of life, respectively [1, 2]. The gold standard treatment of BPH is the transurethral resection of the prostate (TURP). Unfortunately, men who undergo TURP have considerable sexual dysfunction, including retrograde ejaculation (RE). Up to 66.1% of men who undergo TURP report RE [3]. RE will also affect three out of four men treated with Holmium laser enucleation of the prostate (HoLeP) [4].
In the last several decades, multiple treatments have been introduced for the treatment of BPH to not only treat lower urinary tract symptoms (LUTS) (Fig. 1) but also have potentially fewer sexual side effects. RE occurs when the sphincter of the bladder neck fails to contract to cause the semen to reflux into the urinary bladder. RE often occurs after BPH treatments which do not preserve or affect the bladder neck. This may be avoided in treatments that do not directly affect the bladder neck, such as novel minimally invasive techniques.
With a modern emphasis on improved quality of life in patients suffering from BPH, there has been an impetus to develop ejaculatory-preserving minimally invasive techniques. The present systematic review aimed to explore the sexual side effects of these novel minimally invasive surgical procedures for BPH-related LUTS, with an emphasis on EjD
Surgical Treatments
*Water Vapor Thermal Therapy
*Prostatic Urethral Lift
*Prostate Artery Embolization
*Aquablation
Conclusions
The systematic review of novel modalities for BPH-related LUTS revealed improved post-operative ejaculation metrics compared to traditional treatment. The water vapor thermal therapy of Rezūm, PUL or UroLift®, PAE, and Aquablation showed acceptable rates of RE and had very low adverse events related to the procedure. Ultimately, all four treatment modalities are comparable in terms of sexual side effects, with clinical trials of Rezūm, PUL, and PAE showing minimal to no RE events postoperatively. PUL and Rezum both demonstrated lower rates of ejaculatory dysfunction while preserving MSHQ-EjD scores when compared to PAE and Aquablation. Further research is required to directly compare these treatment modalities in a randomized clinical trial.
