Systematic review of lower urinary tract symptoms/benign prostatic hyperplasia surgical treatments on men's ejaculatory function: Time for a bespoke approach?

Abstract

Although ejaculatory dysfunction is common for patients undergoing benign prostatic hyperplasia surgery, no clear evidence is present to counsel men seeking to preserve ejaculation. Our aim was to evaluate ejaculatory dysfunction in relation to benign prostatic hyperplasia surgery. We carried out a web and manual search using MEDLINE and Embase including randomized controlled trials reporting ejaculatory dysfunction after benign prostatic hyperplasia surgery: 42 randomized controlled trials comprising a total of 3857 patients were included. Only one study had ejaculatory dysfunction as a primary outcome, and just 10 evaluated ejaculatory dysfunction before and after surgery. The definition of ejaculatory dysfunction was not standardized. Similarly, just seven studies used internationally validated questionnaires to address ejaculatory dysfunction. The reported rates of ejaculatory dysfunction after resectional elecrosurgery, laser procedures, coagulation, ablation and implant techniques were assessed and compared. Transurethral resection of the prostate and recent laser procedures including holmium, thulium and GreenLight cause similar rates of ejaculatory dysfunction, occurring in almost three out of four to five men. Although providing less symptomatic benefit compared with transurethral resection of the prostate, transurethral incision of the prostate, transurethral needle ablation and transurethral microwave thermotherapy should be considered for men aiming to maintain normal ejaculation. UroLift is also a recent promising option for this category of patients. The vast majority of studies reporting ejaculatory dysfunction after benign prostatic hyperplasia surgery used poor methodology to investigate this complication. Future studies able to address clear hypothesis and considering ejaculatory dysfunction anatomical and pathophysiological features are required to develop ejaculation preserving techniques and to increase the evidence to counsel men aiming to preserve ejaculation.

Ejaculatory dysfunction in the treatment of lower urinary tract symptoms

“…The AUA BPH guideline panel estimates the incidence of of EjD with TURP at 65% (2). Consistent with this a review of 30 RCTs involving TURP showed the rate of EjD at 66.1% (8). It must be appreciated however that pre-operative ejaculatory dysfunction is common in men undergoing TURP being estimated around 30–35%.…”

Impact of Thulium Laser Enucleation of the Prostate on Erectile, Ejaculatory and Urinary Functions

“…A recent systematic review by Marra et al [21] has evaluated the impact of all actual surgical techniques for BPH treatment on ejaculatory function. The ‘dry orgasm' because of the retrograde flow of semen is considered an afterthought by clinicians counselling patients before BPH surgery, even if a rising interest for ejaculation preservation is in the process of being developed.…”

UroLift: a new minimally-invasive treatment for benign prostatic hyperplasia

“…Sexual function is increasingly recognized and measured as an important primary outcome. Furthermore, research has shown erectile dysfunction to have a greater impact on quality of life than LUTS [Marra et al 2015]. As such, the development of UroLift should be praised in identifying this therapeutic void and acting upon it.…”