To assess how much Holmium laser enucleation of the prostate (HoLEP) is detrimental on men sexuality.
Between January and December 2013, all patients presented for BPH surgery were assessed using IIEF-15 (international index of erectile function-15) and Ej-MSHQ (ejaculatory domain-male sexual health questionnaire). Changes in men’s sexuality following HoLEP in relation to control procedure were prospectively assessed. Intervention group included legible consecutive patients treated by HoLEP. Control group included legible patients presented for diagnostic cystoscopy. Changes in IIEF-15, its subdomains and Ej-MSHQ scores were compared between HoLEP group and control.
At one year 80 and 70 subjects were included for final analysis following HoLEP and control groups, respectively. Regardless of the baseline erectile function (EF/IIEF) score, there was an increase in EF score similar to control following HoLEP (P = 0.6). However, among subjects with normal preoperative EF (score >25), in comparison with control, there was similar decline in EF score following HoLEP (P = 0.07). Regarding the orgasm domain, there was a significant reduction in orgasm perception following HoLEP in relation to control (P = 0.01). Patients reported desire changes, intercourse satisfaction and overall satisfaction scores similar to control following HoLEP. Using Ej-MSHQ score, there was no statistically significant difference between HoLEP and control groups in percentage of subjects reporting ejaculatory dysfunction at baseline. However, at 12 months, there was statistically significant more ejaculatory dysfunction reporting following HoLEP. The most common ejaculatory abnormality was volume abnormality. Orgasm perception was significantly decreased among subjects with newly reported ejaculatory dysfunction (5.3 ± 1.4 vs. 8.6 ± 1.3, P = 0.001).
Controlled short-term assessment of HoLEP showed potential negative impact on EF in patients with normal preoperative EF. Apart from orgasm perception, sexual function changes following HoLEP were similar to control. High prevalence of postoperative ejaculatory dysfunction following HoLEP remained notable finding.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Elshal AM, Elmansy HM, Elhilali MM (2013) Transurethral laser surgery for benign prostate hyperplasia in octogenarians: safety and outcomes. Urology 81(3):634–639
Elshal AM, Elmansy HM, Elkoushy MA et al (2012) Male sexual function outcome after three laser prostate surgical techniques: a single center perspective. Urology 80(5):1098–1104
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
Emberton M, Neal DE, Black N et al (1996) The effect of prostatectomy on symptom severity and quality of life. Br J Urol 77(2):233–247
Tscholl R, Largo M, Poppinghaus E et al (1995) Incidence of erectile impotence secondary to transurethral resection of benign prostatic hyperplasia, assessed by preoperative and postoperative Snap Gauge tests. J Urol 153(5):1491–1493
Jaidane M, Arfa NB, Hmida W et al (2010) Effect of transurethral resection of the prostate on erectile function: a prospective comparative study. Int J Impot Res 22(2):146–151
Wasson JH, Reda DJ, Bruskewitz RC et al (1995) A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia. The Veterans Affairs Cooperative Study Group on Transurethral Resection of the Prostate. N Engl J Med 332(2):75–79
Elshal AM, Mekkawy R, Laymon M et al (2016) Holmium laser enucleation of the prostate for treatment for large-sized benign prostate hyperplasia; is it a realistic endourologic alternative in developing country? World J Urol 34(3):399–405
Braun M, Wassmer G, Klotz T et al (2000) Epidemiology of erectile dysfunction: results of the ‘Cologne Male Survey’. Int J Impot Res 12(6):305–311
Meng F, Gao B, Fu Q et al (2007) Change of sexual function in patients before and after Ho:YAG laser enucleation of the prostate. J Androl 28(2):259–261
Bruyere F, Puichaud A, Pereira H et al (2010) Influence of photoselective vaporization of the prostate on sexual function: results of a prospective analysis of 149 patients with long-term follow-up. Eur Urol 58(2):207–211
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
Wilson LC, Gilling PJ, Williams A et al (2006) A randomised trial comparing holmium laser enucleation versus transurethral resection in the treatment of prostates larger than 40 grams: results at 2 years. Eur Urol 50(3):569–573
Klett DE, Tyson MD 2nd, Mmeje CO et al (2014) Patient-reported sexual outcomes after holmium laser enucleation of the prostate: a 3-year follow-up study. Urology 84(2):421–426
Dowrick AS, Wootten AC, Murphy DG et al (2015) “We used a validated questionnaire”: what does this mean and is it an accurate statement in urologic research? Urology 85(6):1304–1311
Elshal AM, Elkoushy MA, Elhilali MM (2013) V412 Evaluation of a new enucleating loop for holmium laser enucleation of the prostate (HoLEP); pilot study. J Urol 189(4s):e166–e167
Rosen RC, Riley A, Wagner G et al (1997) The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 49(6):822–830
Rosen RC, Catania J, Pollack L et al (2004) Male sexual health questionnaire (MSHQ): scale development and psychometric validation. Urology 64(4):777–782
El-Assmy A, Benhassan M, Harraz AM et al (2015) Ejaculatory function after anastomotic urethroplasty for pelvic fracture urethral injuries. Int Urol Nephrol 47(3):497–501
Sealed.Envelope.Ltd. (2012) Power calculator for continuous outcome equivalence trial [cited 2013 Dec 14]. http://www.sealedenvelope.com/power/continuous-equivalence/
Welliver C, Kottwitz M, Feustel P et al (2015) Clinically and statistically significant changes seen in sham surgery arms of randomized controlled benign prostatic hyperplasia surgery trials. J Urol 194(6):1682–1687
Akman T, Binbay M, Tekinarslan E et al (2013) Effects of bipolar and monopolar transurethral resection of the prostate on urinary and erectile function: a prospective randomized comparative study. BJU Int 111(1):129–136
Mamoulakis C, Skolarikos A, Schulze M et al (2013) Bipolar vs monopolar transurethral resection of the prostate: evaluation of the impact on overall sexual function in an international randomized controlled trial setting. BJU Int 112(1):109–120
Placer J, Salvador C, Planas J et al (2015) Effects of holmium laser enucleation of the prostate on sexual function. J Endourol Endourol Soc 29(3):332–339
Frieben RW, Lin HC, Hinh PP et al (2010) The impact of minimally invasive surgeries for the treatment of symptomatic benign prostatic hyperplasia on male sexual function: a systematic review. Asian J Androl 12(4):500–508
Lefaucheur JP, Yiou R, Salomon L et al (2000) Assessment of penile small nerve fiber damage after transurethral resection of the prostate by measurement of penile thermal sensation. J Urol 164(4):1416–1419
McVary KT, Gange SN, Shore ND et al (2014) Treatment of LUTS secondary to BPH while preserving sexual function: randomized controlled study of prostatic urethral lift. J Sex Med 11(1):279–287
Kim SY, Frank S, Holloway R et al (2005) Science and ethics of sham surgery: a survey of Parkinson disease clinical researchers. Arch Neurol 62(9):1357–1360
Conflict of interest
The authors declare that they have no conflicts of interest.
All procedures performed in our study were 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.
Informed consent was obtained from all individual participants included in the study.
About this article
Cite this article
Elshal, A.M., El-Assmy, A., Mekkawy, R. et al. Prospective controlled assessment of men’s sexual function changes following Holmium laser enucleation of the prostate for treatment of benign prostate hyperplasia. Int Urol Nephrol 49, 1741–1749 (2017). https://doi.org/10.1007/s11255-017-1649-0
- Benign prostate hyperplasia