Ejaculation-sparing thulium laser enucleation of the prostate (ES-ThuLEP): outcomes on a large cohort

Abstract

Purpose To assess the effects of a new ejaculation-sparing thulium laser enucleation of the prostate (ES-ThuLEP) technique on sexual functions and micturition, in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) and to evaluate how the surgical technique of ES-ThuLEP can lead to ejaculation preservation. Methods A prospective study was carried out between January 2015 and January 2018 on patients with surgical indication for BPH, who wished to preserve ejaculation. The patients were treated with ES-ThuLEP and were evaluated before and 3 and 6 months after surgery. Three validated questionnaires (ICIQ-MLUTSsex, IIEF-5 and IPSS) were used to assess changes in ejaculation, erectile function and urinary symptoms. Uroflowmetry (Qmax and Qavg), post-void residual volume and voided volume were also evaluated, to assess micturition improvement. Patients with moderate to severe erectile dysfunction were excluded. Statistical analysis was performed with the Student's t test, Chi-square test and logistic regression analysis. Results Two hundred and eighty three patients were enrolled. Ejaculation was spared in 203 and 219 patients at 3 and 6 months after surgery. No significant differences were observed between erectile function before and after surgery: baseline IIEF-5 = 16.2 ± 4.47 vs 16.7 ± 2.9 (p = 0.419) and 17.7 ± 3.2 (p = 0.410) at 3 and 6 months. Significant improvement in urinary symptoms was achieved: baseline IPSS = 19.4 ± 7.24 vs 5.8 ± 4.3 (p = 0.032) and 3.9 ± 4.1 (p = 0.029) at 3 and 6 months. Conclusion ES-ThuLEP effectively preserved ejaculation in over two thirds of the patients without compromising micturition improvement or erectile function. ES-ThuLEP could be a valid treatment option for BPH in young and sexually active men.

Assessment of Sexual Outcomes in Patients Undergoing Thulium Laser Prostate Surgery for Management of Benign Prostate Hyperplasia: A Systematic Review and Meta-analysis

“…This systematic review and meta-analysis included a total of thirteen studies, 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 out of which five 31 , 32 , 33 , 34 , 35 were comparative clinical studies on the sexual outcomes between the Tm:YAG prostate surgery and TURP, and eight 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 were single arm interventional prospective cohort studies assessing sexual outcomes after Tm:YAG for BPH.…”

“…We included 8 prospective cohorts 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 with a total of 1167 patients with BPH treated with Tm:YAG prostate surgery. 4 of the studies 36 , 37 , 38 , 42 used the TmLEP technique, three 40 , 41 , 43 used the TmVEP, and one 39 used the TmLRP. The thulium lasers used ranged from 90 to 120 W and the follow-ups ranged from 1 to 18 months.…”

“…We analyzed data from 7 non comparative prospective cohort studies 36 , 37 , 38 , 39 , 41 , 42 , 43 to assess the overall IIEF-5 score improvements at different follow-up times. We found 3 studies 36 , 37 , 38 assessing IIEF-5 scores after 3 months, 4 36 , 37 , 38 , 39 assessing the scores after 6 months, and 3 41 , 42 , 43 assessing the scores after 12 months. However, only 1 study reported the IIEF5 score at 18 months.…”

Determination of Face and Content Validity of Cadaveric Model for Holmium Anatomic Endoscopic Enucleation of the Prostate Training: An ESUT AEEP Group Study

“…Different AEEP techniques (eg, three-lobe and enblock) have been reported in the literature [2] , [30] . We focused on the “omega sign” AEEP technique because it represents our standard of care technique, other than for its favorable perioperative and functional outcomes [31] .…”

Electrosurgery or laser for benign prostatic enlargement: trumpcard or pitfalls

“…The prospectively assessed outcomes of 283 patients showed preservation of antegrade ejaculation in 71.7% at 3 months and 77.4% at 6 months after surgery. Comparable to the other modified EEP techniques, functional micturition outcomes improved significantly, and complication rates were low [ 26 ▪ ].…”