The impact of surgical treatments for lower urinary tract symptoms/benign prostatic hyperplasia on male erectile function

Abstract

Lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) is common in adult men and can impair erectile function (EF). It was believed surgical treatments for this illness can improve EF due to the relief of LUTS while they were also reported harmed EF as heating or injury effect. Current network meta-analysis aimed to elucidate this discrepancy.Randomized controlled trials (RCTs) were identified. Direct comparisons were conducted by STATA and network meta-analysis was conducted by Generate Mixed Treatment Comparison. Random-effects models were used to calculate pooled standard mean difference and 95% confidence intervals and to incorporate variation between studies.Eighteen RCTs with 2433 participants were analyzed. Nine approaches were studied as transurethral resection of the prostate (TURP), plasmakinetic resection of the prostate (PKRP), plasmakinetic enucleation of the prostate (PKEP), Holmium laser enucleation of the prostate (HoLEP), Holmium laser resection of the prostate (HoLRP), photoselective vaporization of the prostate (PVP), Thulium laser, open prostatectomy (OP), and laparoscopic simple prostatectomy (LSP). In direct comparisons, all surgical treatments did not decrease postoperative International Index of Erectile Function (IIEF)-5 score except PVP. Moreover, patients who underwent HoLEP, PKEP, Thulium laser, and TURP had their postoperative EF significantly increased. Network analysis including direct and indirect comparisons ranked LSP at the highest position on the variation of postoperative IIEF-5 score, followed by PKRP, HoLEP, TURP, Thulium laser, PKEP, PVP, HoLRP, and OP. In subgroup analysis, only PVP was found lower postoperative EF in the short term and decreased baseline group, whereas TURP increased postoperative IIEF-5 score only for patients with normal baseline EF. However, HoLEP and PKEP showed pro-erectile effect even for patients with decreased baseline EF and short-term follow-up. Our novel data demonstrating surgical treatments for LUTS/BPH showed no negative impact on postoperative EF except PVP. Moreover, HoLEP and PKEP were found pro-erectile effect for all subgroups. New technologies, such as LSP, PKRP, and Thulium laser, were ranked at top positions in the network analysis, although they had no pro-erectile effect in direct comparison due to limited original studies or poor baseline EF. Therefore, further studies and longer follow-up are required to substantiate our findings.

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

“…The authors believed, however, that the reason for such decrease is the neurovascular bundles damage, because of the generated monopolar current passed in close proximity to the prostatic capsule [ 20 ]. This theory was in part confirmed by Li et al [ 21 ], as they indicated in their meta-analysis a predominantly small EF decrease during a short-term follow-up. However, at a follow-up of 12 months after TURP, the average EF values returned to normal and did not differ from those recorded preoperatively, especially in patients presenting with an initially high EF value [ 21 ].…”

“…This theory was in part confirmed by Li et al [ 21 ], as they indicated in their meta-analysis a predominantly small EF decrease during a short-term follow-up. However, at a follow-up of 12 months after TURP, the average EF values returned to normal and did not differ from those recorded preoperatively, especially in patients presenting with an initially high EF value [ 21 ].…”

Minimizing Sexual Dysfunction in BPH Surgery

“…Incidence of new-onset REj rates were reported at 30–67.1% with an additional 5.4% risk of developing painful ejaculation after PVP [44, 46, 47]. Although single institutional studies have shown no detrimental effects of PVP on erectile function, a recent meta-analysis by Li et al demonstrated that of the nine BPH procedures analyzed, PVP was the only one to negatively impact short-term postoperative erectile function [46, 48, 49]. It is also important to note that studies utilizing higher laser energy levels have a higher propensity to developing sexual dysfunction [19].…”

Investigation of prostate resected weight on postoperative sexual dysfunction following transurethral resection of prostate surgery: a population-based study

“…Some researchers reported that drug administration or surgical intervention improves symptoms of lower urinary tract syndrome as well as ED 3–5. Additionally, Li et al reported that 14% of all patients who received surgical intervention had some resolution of ED symptoms; however, the authors also reported that 16% of patients experienced worsening symptoms postoperatively 6. On the other hand, another study indicated that nerve injury-related electroporation heat may result in postoperative ED 7…”

“…Theoretically, the larger the weight of the prostate part to be removed, the higher the risk of ED-related nerve damage. Recent studies of the association between TURP and postoperative ED focused on different surgical intervention methods, the difference between drug administration and surgical intervention, and the effects of bipolar and unipolar electroporation 6,9–11. However, few studies have examined the relation between the resected prostate weight and postoperative, new-onset ED.…”