Impact of endoscopic enucleation of the prostate with thulium fiber laser on the erectile function

Abstract

BackgroundThe impact of number of endoscopic enucleation of the prostate techniques (holmium laser enucleation - HoLEP for example) on erectile function have already been investigated. However, the thulium-fiber laser, in this setting remains unstudied. In this study, we compared sexual function outcomes in patients with benign prostatic hyperplasia (BPH) treated with transurethral resection of the prostate (TURP) or thulium-fiber laser enucleation (ThuFLEP).MethodsWe performed a retrospective analysis of patients who underwent transurethral resection and endoscopic enucleation of the prostate for BPH; inclusion criteria was the presence of infravesical obstruction (IPSS > 20, Qmax < 10 mL/s). Erectile function (EF) was assessed using the International Index of Erectile Function (IIEF-5) both prior to endoscopic examination, and six months after.ResultsA total of 469 patients with BPH were included in the study; of these, 211 underwent to ThuFLEP, and 258 TURP. Preoperative IIEF-5 in TURP and ThuFLEP groups were 11.7 (±4.5) and 11.1 (±5.0), respectively (p = 0.17). At six month the IIEF-5 score was unchanged (p = 0.26 and p = 0.08) and comparable in both groups (p = 0.49). However, mean IIEF-5 score shown significant increase of 0.72 in ThuFLEP group, comparing to decrease of 0.24 in TURP patients (p < 0.001).ConclusionsBoth TURP and ThuFLEP are effective modalities in the management of infravesical obstruction due to BPH. At six months follow-up after surgery, both techniques lead to comparable IIEF-5 score. However, our results demonstrated that the ThuFLEP is more likely to preserve the erectile function leading to increase of IIEF-5 at six months in contrast to TURP which lead to slight drop in IIEF-5 score.

Novel thulium fiber laser for endoscopic enucleation of the prostate: A prospective comparison with conventional transurethral resection of the prostate

“…The present results confirmed the high efficacy of both Tm‐fiber enucleation and TURP in the management of LUTS and benign prostatic obstruction. Both techniques had favorable functional outcomes that had previously been proven in a number of trials . No difference between resection and enucleation was found.…”

A Systematic Review of Thulium Fiber Laser: Applications and Advantages of Laser Technology in the Field of Urology

“…A further study compared ThuFLEP with Transurethral Resection of Prostate (TURP) for BPH, with both modalities being equally effective at resolving LUTS at 6 months postoperatively. 23 Interestingly, patients receiving ThuFLEP had a significant improvement in erectile function on average postoperatively. The authors suggest that this is due to TFL's shallower penetration depth, allowing safer incisions with a lower risk of surgical capsule penetration and therefore less damaging on neurovascular bundles at the posterolateral surface of the prostate.…”

“…22 In a retrospective study, Enikeev et al found ThuFLEP to significantly improve erectile function. 23…”

Sexual outcomes of endoscopic enucleation of prostate

“…Erectile function after ThuLEP had no significant change in two prospective and two retrospective studies with sexual function defined as primary outcomes (Carmignani et al., 2015; Enikeev et al., 2018; Saredi et al., 2016; Wang, Shao, Lu, Lu, & Li, 2014). These might be explained by a consolidated enucleation technique with minimal capsular perforation and minimised energy conduction beyond capsule, reducing post‐operative neurapraxia (Saredi et al., 2016).…”