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Sexual and ejaculatory function after holmium laser enucleation of the prostate and bipolar transurethral enucleation of the prostate: a single-center experience

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Abstract

Currently available surgical treatments for Lower Urinary Tract Symptoms (LUTS) due to Benign Prostatic Obstruction (BPO) are associated with an increased risk of sexual dysfunction. The aim of our study is to compare sexual and ejaculatory function after Holmium Laser Enucleation of the Prostate (HoLEP) and Bipolar Transurethral Enucleation of the Prostate (B-TUEP). We performed a retrospective analysis of data prospectively collected from 62 (44.9%) and 76 (55.1%) patients who underwent HoLEP and B-TUEP, respectively. Erectile function and ejaculation characteristics were assessed with the International Index of Erectile Function–Erectile Function (IIEF-EF) domain and the Male Sexual Health Questionnaire-Ejaculatory function (MSHQ-EJ) questionnaires. Our study recorded no change in erectile function and no significant difference in rates of preserved antegrade ejaculation after both surgeries. One month after surgery, rates of physical pain/discomfort and perceived decreased physical pleasure during ejaculation were higher in HoLEP than B-TUEP patients (all p < 0.03). Moreover, HoLEP patients were more bothered by their ejaculatory difficulties than B-TUEP men (p = 0.03). At 3- and 12-months follow-up, all ejaculation-related differences disappeared. In conclusion, both procedures are valid alternatives for BPO treatment as they offer comparable urinary and sexual outcomes in the long term. However, in the first month after surgery, HoLEP patients present with more ejaculatory difficulties.

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Fig. 1: Physical pain or discomfort during ejaculation at baseline and at 1, 3, 12 months follow-up assessment after HoLEP and B-TUEP.
Fig. 2: Reduced volume of semen at baseline and at 1, 3, 12 months follow-up assessment after HoLEP and B-TUEP.
Fig. 3: Decreased physical pleasure during ejaculation at baseline and at 1, 3, 12 months follow-up assessment after HoLEP and B-TUEP.

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Authors and Affiliations

  1. Department of Urology, Foundation IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, University of Milan, Milan, Italy

    Carolina Bebi, Matteo Turetti, Elena Lievore, Francesco Ripa, Marco Bilato, Lorenzo Rocchini, Andrea Gallioli, Matteo Giulio Spinelli, Elisa De Lorenzis, Giancarlo Albo, Fabrizio Longo, Franco Gadda, Paolo Guido Dell’Orto, Emanuele Montanari & Luca Boeri

  2. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Elisa De Lorenzis, Giancarlo Albo & Emanuele Montanari

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  1. Carolina Bebi
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Bebi, C., Turetti, M., Lievore, E. et al. Sexual and ejaculatory function after holmium laser enucleation of the prostate and bipolar transurethral enucleation of the prostate: a single-center experience. Int J Impot Res 34, 71–80 (2022). https://doi.org/10.1038/s41443-020-00366-8

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