Do patients have to choose between ejaculation and miction? A systematic review about ejaculation preservation technics for benign prostatic obstruction surgical treatment
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Ejaculatory dysfunction is the most common side effect related to surgical treatment of benign prostatic obstruction (BPO). Nowadays, modified surgical techniques and non-ablative techniques have emerged with the aim of preserving antegrade ejaculation. Our objective was to conduce a systematic review of the literature regarding efficacy on ejaculatory preservation of modified endoscopic surgical techniques, and mini-invasive non-ablatives techniques for BPO management.
A systematic review of the literature was carried out on the PubMed database using the following MESH terms: “Prostatic Hyperplasia/surgery” and “Ejaculation”, in combination with the following keywords: “ejaculation preservation”, “photoselective vaporization of the prostate”, “photoselective vapo-enucleation of the prostate”, “holmium laser enucleation of the prostate”, “thulium laser”, “prostatic artery embolization”, “urolift”, “rezum”, and “aquablation”.
The ejaculation preservation rate of modified-TURP ranged from 66 to 91%. The ejaculation preservation rate of modified-prostate photo-vaporization ranged from 87 to 96%. The only high level of evidence studies available compared prostatic urethral lift (PUL) and aquablation versus regular TURP in prospective randomized-controlled trials. The ejaculation preservation rate of either PUL or aquablation compared to regular TURP was 100 and 90 versus 34%, respectively.
Non-ablative therapies and modified endoscopic surgical techniques seemed to be reasonable options for patients eager to preserve their ejaculatory functions.
KeywordsBenign prostatic hyperplasia Ejaculation preservation Endoscopic surgery Ejaculatory dysfunction Lower urinary tract symptoms Retrograde ejaculation
SL: project development, data collection, and manuscript writing. AC: project development, data collection, and manuscript writing. NBD, AB, JNC, AD, SD, MF, BP, VM, GR, and PET: project development and reviewing.
Compliance with ethical standards
Conflict of interest
Armand Chevrot: none. Nicolas Barry Delongchamps: none. Amin Benchikh: none. Jean Nicolas Cornu: none. Aurélien Descazeaud: consultant for Bouchara Recordati, Pierre Fabre Medicament, Lilly, investigator pour EDAP TMS. Steeve Doizi: none. Marc Fourmarier: consultant for GSK and EDAP TMS. Souhil Lebdai: none. Benjamin Pradère: none. Vincent Misraï: none. Gregoire Robert: consultant for Pierre Fabre Medicament, investigator for EDAP TMS. Pierre Etienne Theveniaud: none.
Research involving human participants and/or animals
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