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

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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.

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References

  1. Lee SWH, Chan EMC, Lai YK (2017) The global burden of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a systematic review and meta-analysis. Sci Rep 7(1):7984

    Article  Google Scholar 

  2. Rosen R, Altwein J, Boyle P et al (2003) Lower urinary tract symptoms and male sexual dysfunction: the multinational survey of the aging male (MSAM-7). Eur Urol 44(6):637–649

    Article  Google Scholar 

  3. Naspro R, Gomez Sancha F, Manica M et al (2017) From “gold standard” resection to reproducible “future standard” endoscopic enucleation of the prostate: what we know about anatomical enucleation. Minerva Urol Nefrol 69(5):446–458

    PubMed  Google Scholar 

  4. Herrmann TR (2016) Enucleation is enucleation is enucleation is enucleation. World J Urol 34(10):1353–1355

    Article  Google Scholar 

  5. Gilling PJ, Kennett K, Das AK et al (1998) Holmium laser enucleation of the prostate (HoLEP) combined with transurethral tissue morcellation: an update on the early clinical experience. J Endourol 12(5):457–459

    Article  CAS  Google Scholar 

  6. Herrmann TR, Bach T, Imkamp F et al (2010) Thulium laser enucleation of the prostate (ThuLEP): transurethral anatomical prostatectomy with laser support. Introduction of a novel technique for the treatment of benign prostatic obstruction. World J Urol 28(1):45–51

    Article  Google Scholar 

  7. Bozzini G, Seveso M, Melegari S et al (2017) Thulium laser enucleation (ThuLEP) versus transurethral resection of the prostate in saline (TURis): a randomized prospective trial to compare intra and early postoperative outcomes. Actas Urol Esp 41(5):309–315

    Article  CAS  Google Scholar 

  8. Sun F, Sun X, Shi Q et al (2018) Transurethral procedures in the treatment of benign prostatic hyperplasia: a systematic review and meta-analysis of effectiveness and complications. Medicine (Baltimore) 97(51):e13360

    Article  Google Scholar 

  9. Lin Y, Wu X, Xu A et al (2016) Transurethral enucleation of the prostate versus transvesical open prostatectomy for large benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials. World J Urol 34(9):1207–1219

    Article  Google Scholar 

  10. Zhang J, Ou Z, Zhang X et al (2019) Holmium laser enucleation of the prostate versus thulium laser enucleation of the prostate for the treatment of large-volume prostates > 80 ml: 18-month follow-up results. World J Urol. https://doi.org/10.1007/s00345-019-02945-x

    Article  PubMed  PubMed Central  Google Scholar 

  11. Gravas S, Cornu JN, Gacci M et al (2019) EAU guidelines on management of non-neurogenic male lower urinary tract symptoms (LUTS) incl. benign prostatic obstruction (BPO). EAU Guidelines Office, Arnhem, The Netherlands. https://uroweb.org/guideline/treatment-of-non-neurogenic-male-luts/

  12. DeLay KJ, Nutt M, McVary KT (2016) Ejaculatory dysfunction in the treatment of lower urinary tract symptoms. Transl Androl Urol 5(4):450–459

    Article  Google Scholar 

  13. Marra G, Sturch P, Oderda M et al (2016) Systematic review of lower urinary tract symptoms/benign prostatic hyperplasia surgical treatments on men’s ejaculatory function: time for a bespoke approach? Int J Urol 23(1):22–35

    Article  Google Scholar 

  14. Woo HH, Bolton DM, Laborde E et al (2012) Preservation of sexual function with the prostatic urethral lift: a novel treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Sex Med 9(2):568–575

    Article  Google Scholar 

  15. Albisinni S, Aoun F, Roumeguère T et al (2017) New treatment strategies for benign prostatic hyperplasia in the frail elderly population: a systematic review. Minerva Urol Nefrol 69(2):119–132

    PubMed  Google Scholar 

  16. Gratzke C, Barber N, Speakman MJ et al (2017) Prostatic urethral lift vs transurethral resection of the prostate: 2-year results of the BPH6 prospective, multicentre, randomized study. BJU Int 119(5):767–775

    Article  Google Scholar 

  17. Lebdai S, Chevrot A, Doizi S et al (2019) Do patients have to choose between ejaculation and miction? A systematic review about ejaculation preservation technics for benign prostatic obstruction surgical treatment. World J Urol 37(2):299–308

    Article  Google Scholar 

  18. Marberger H (1974) The mechanisms of ejaculation. Basic Life Sci 4(PT. B):99–110

    CAS  PubMed  Google Scholar 

  19. Gallizia P (1972) The smooth sphincter of the vesical neck, a genital organ. Urol Int 27(4):341–354

    Article  CAS  Google Scholar 

  20. Sturch P, Woo HH, McNicholas T et al (2015) Ejaculatory dysfunction after treatment for lower urinary tract symptoms: retrograde ejaculation or retrograde thinking? BJU Int 115(2):186–187

    Article  Google Scholar 

  21. Gil-Vernet JM Jr, Alvarez-Vijande R, Gil-Vernet A et al (1994) Ejaculation in men: a dynamic endorectal ultrasonographical study. Br J Urol 73(4):442–448

    Article  Google Scholar 

  22. Dorschner W, Stolzenburg JU (1994) A new theory of micturition and urinary continence based on histomorphological studies. 3. The two parts of the musculus sphincter urethrae: physiological importance for continence in rest and stress. UrolInt 52(4):185–188

    CAS  Google Scholar 

  23. Ronzoni G, De Vecchis M (1998) Preservation of anterograde ejaculation after transurethral resection of both the prostate and bladder neck. Br J Urol 81(6):830–833

    Article  CAS  Google Scholar 

  24. Alloussi SH, Lang C, Eichel R et al (2014) Ejaculation-preserving transurethral resection of prostate and bladder neck: short- and long-term results of a new innovative resection technique. J Endourol 28(1):84–89

    Article  Google Scholar 

  25. Talab SS, Santiago-Lastra YA, Bachmann A et al (2013) The impact of ejaculation-preserving photo-selective vaporization of the prostate (EP-PVP) on lower urinary tract symptoms and ejaculatory function: results of a multicenter study. J Urol 189(4):e164

    Google Scholar 

  26. Vickers AJ, Sjoberg DD (2015) Guidelines for reporting of statistics in European urology. EurUrol 67:181–187

    Google Scholar 

  27. Briganti A, Naspro R, Gallina A et al (2006) Impact on sexual function of holmium laser enucleation versus transurethral resection of the prostate: results of a prospective, 2-center, randomized trial. J Urol 175(5):1817–1821

    Article  Google Scholar 

  28. Carmignani L, Bozzini G, Macchi A et al (2015) Sexual outcome of patients undergoing thulium laser enucleation of the prostate for benign prostatic hyperplasia. Asian J Androl 17(5):802–806

    PubMed  PubMed Central  Google Scholar 

  29. Cacciamani GE, Cuhna F, Tafuri A et al (2019) Anterograde ejaculation preservation after endoscopic treatments in patients with bladder outlet obstruction: systematic review and pooled-analysis of randomized clinical trials. Minerva Urol Nefrol 71(5):427–434

    Article  Google Scholar 

  30. Kim M, Song SH, Ku JH et al (2015) Pilot study of the clinical efficacy of ejaculatory hood sparing technique for ejaculation preservation in Holmium laser enucleation of the prostate. Int J Impot Res 27(1):20–24

    Article  CAS  Google Scholar 

  31. Gravas S, Bachmann A, Reich O et al (2011) Critical review of lasers in benign prostatic hyperplasia (BPH). BJU Int 107(7):1030–1043

    Article  Google Scholar 

Download references

Funding

The authors declare that no extra institutional funding was received.

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Authors and Affiliations

  1. Department of Urology, ASST Valle Olona, Ospedale di Busto Arsizio (VA), Busto Arsizio, Italy

    Giorgio Bozzini, Lorenzo Berti, Matteo Maltagliati, Umberto Besana, Alberto Calori & Carlo Buizza

  2. Department of Urology, Università degli Studi di Modena e Reggio Emilia (MO), Modena, Italy

    Lorenzo Berti, Matteo Maltagliati, Maria Chiara Sighinolfi, Salvatore Micali & Bernardo Rocco

  3. Department of Urology, Spital Limmattal, Schlieren, Switzerland

    Alexander Müller

  4. Department of Urology, Sapienza Università di Roma, Latina, Italy

    Antonio Luigi Pastore

  5. Department of Urology, Hospital Clìnico Universidad de Chile, Santiago, Chile

    Rodrigo Ledezma

  6. Department of Urology, Clinica Sant’Anna, Lugano, Switzerland

    Paolo Broggini

Authors
  1. Giorgio Bozzini
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  2. Lorenzo Berti
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  3. Matteo Maltagliati
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  4. Umberto Besana
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  5. Alberto Calori
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  6. Alexander Müller
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  7. Maria Chiara Sighinolfi
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  8. Salvatore Micali
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  9. Antonio Luigi Pastore
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  10. Rodrigo Ledezma
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  11. Paolo Broggini
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  12. Bernardo Rocco
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  13. Carlo Buizza
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Contributions

Protocol/project development: GB, LB, UB, CB, AC, MM, SM, BR. Data collection or management: GB, PB, RL, MM, ALP, MCS. Data analysis: GB, RL, ALP, MCS. Manuscript writing/editing: GB, LB. Execution of surgical procedures: GB. Supervision: GB, CB, SM, AM, BR.

Corresponding author

Correspondence to Giorgio Bozzini.

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Conflict of interest

The authors declare that they have no conflict of interest or any known competing financial interests.

Ethical approval

The study was performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by our local Ethical Commitee.

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Informed consent was obtained from all individual participants included in the study.

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All patients gave their consent for the publication of this article.

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Bozzini, G., Berti, L., Maltagliati, M. et al. Ejaculation-sparing thulium laser enucleation of the prostate (ES-ThuLEP): outcomes on a large cohort. World J Urol 39, 2029–2035 (2021). https://doi.org/10.1007/s00345-020-03442-2

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  • DOI: https://doi.org/10.1007/s00345-020-03442-2

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