Abstract
Purpose
To present the step-by-step description of an ejaculation-sparing anatomic photo-selective vaporization of the prostate (PVP) technique. To report the results of a series of ejaculation-sparing versus non-ejaculation-sparing anatomic PVPs.
Methods
Sexually active, benign prostatic hyperplasia (BPH) patients undergoing an anatomic PVP between 11/2018 and 2/2020 were included. Patients were divided into group A (ejaculation-sparing surgery) and group B (control group). Baseline, peri-operative and 6-months follow-up data were evaluated. Lower urinary tract symptoms (LUTS) and sexual function were assessed through internationally validated questionnaires. Groups were matched by an inverse probability of treatment weighting (IPTW) analysis. Logistic univariable regression analysis was performed to detect predictors of antegrade ejaculation preservation.
Results
Overall, 76 patients were included, among which 15 in group A and 61 in group B. Median (inter-quartile range, IQR) age was 72 (66.5–77) years, median (IQR) prostate volume 63.5 (54.5–98.5) cc. No differences about peri-operative outcomes were detected, included high-grade complications. At 6-months follow-up, no differences in urinary or erectile function were detected between groups, while ejaculation-sparing patients showed better Male Sexual Health Questionnaire (MSHQ) scores [7 (1–13) vs. 1 (1–1), p < 0.001] and higher rates of antegrade ejaculation (60% vs. 13.1%, p < 0.001). The ejaculation-sparing technique was identified as a predictor of post-operative antegrade ejaculation (OR 19.3, CI 95% 7.2–51.2, p < 0.001).
Conclusion
The ejaculation-sparing anatomic PVP showed superiority over the control group in post-operative ejaculatory function scores and antegrade ejaculation rates. Besides, preliminary results suggested similar effectiveness in LUTS relief at a short-term follow-up.
Similar content being viewed by others
References
Gratzke C, Bachmann A, Descazeaud A, Drake MJ, Madersbacher S, Mamoulakis C, Oelke M, Tikkinen KAO, Gravas S (2015) EAU Guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 67:1099–1109. https://doi.org/10.1016/j.eururo.2014.12.038
Rassweiler J, Teber D, Kuntz R, Hofmann R (2006) Complications of transurethral resection of the prostate (TURP)-incidence, management, and prevention. Eur Urol 50:969–980. https://doi.org/10.1016/j.eururo.2005.12.042
El-Assmy A, ElShal AM, Mekkawy R, El-Kappany H, Ibrahiem EHI (2018) Erectile and ejaculatory functions changes following bipolar versus monopolar transurethral resection of the prostate: a prospective randomized study. Int Urol Nephrol 50:1569–1576. https://doi.org/10.1007/s11255-018-1950-6
Gomez Sancha F, Rivera VC, Georgiev G, Botsevski A, Kotsev J, Herrmann T (2015) Common trend: move to enucleation—Is there a case for GreenLight enucleation? Development and description of the technique. World J Urol 33:539–547. https://doi.org/10.1007/s00345-014-1339-9
Badía X, García-Losa M, Dal-Ré R (1997) Ten-language translation and harmonization of the international prostate symptom score: developing a methodology for multinational clinical trials. Eur Urol 31:129–140. https://doi.org/10.1159/000474438
Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peñ BM (1999) Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res 11:319–326. https://doi.org/10.1038/sj.ijir.3900472
Rosen RC, Catania JA, Althof SE, Pollack LM, O’Leary M, Seftel AD, Coon DW (2007) Development and validation of four-item version of male sexual health questionnaire to assess ejaculatory dysfunction. Urology 69:805–809. https://doi.org/10.1016/j.urology.2007.02.036
Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications. Ann Surg 240:205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae
Marra G, Sturch P, Oderda M, Tabatabaei S, Muir G, Gontero P (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 23:22–35. https://doi.org/10.1111/iju.12866
Chung A, Woo HH (2016) Preservation of sexual function when relieving benign prostatic obstruction surgically: can a trade-off be considered? Curr Opin Urol 26:42–48. https://doi.org/10.1097/MOU.0000000000000247
Selman SH (2011) The McNeal prostate: a review. Urology 78:1224–1228. https://doi.org/10.1016/j.urology.2011.07.1395
Leonardi R (2019) The LEST technique: treatment of prostatic obstruction preserving antegrade ejaculation in patients with benign prostatic hyperplasia. Arch Ital di Urol e Androl 91:35–42. https://doi.org/10.4081/aiua.2019.1.35
Master VA, Turek PJ (2001) Ejaculatory physiology and dysfunction. Urol Clin North Am 28:363–376. https://doi.org/10.1016/s0094-0143(05)70145-2
La Vignera S, Aversa A, Cannarella R, Condorelli RA, Duca Y, Russo GI, Calogero AE (2020) Pharmacological treatment of lower urinary tract symptoms in benign prostatic hyperplasia: consequences on sexual function and possible endocrine effects. Expert Opin Pharmacother. https://doi.org/10.1080/14656566.2020.1817382
Gosling JA, Thompson SA (1977) A neurohistochemical and histological study of peripheral autonomic neurons of the human bladder neck and prostate. Urol Int 32:269–276. https://doi.org/10.1159/000280142
Ronzoni G, De Vecchis M (1998) Preservation of anterograde ejaculation after transurethral resection of both the prostate and bladder neck. Br J Urol 81:830–833. https://doi.org/10.1046/j.1464-410x.1998.00658.x
Alloussi SH, Lang C, Eichel R, Alloussi S (2014) Ejaculation-preserving transurethral resection of prostate and bladder neck: short- and long-term results of a new innovative resection technique. J Endourol 28:84–89. https://doi.org/10.1089/end.2013.0093
Kim M, Song SH, Ku JH, Kim HJ, Paick JS (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 27:20–24. https://doi.org/10.1038/ijir.2014.22
Kini M, Te AE, Kashanian JA, Kaplan S, Chughtai B (2020) Ejaculatory hood-sparing photoselective vaporization of the prostate vs. bipolar button plasma vaporization of the prostate in the surgical management of benign prostatic hyperplasia. J Endourol 34:322–329. https://doi.org/10.1089/end.2019.0558
Bozzini G, Berti L, Maltagliati M et al (2020) Ejaculation-sparing thulium laser enucleation of the prostate (ES-ThuLEP): outcomes on a large cohort. World J Urol. https://doi.org/10.1007/s00345-020-03442-2
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 37:299–308. https://doi.org/10.1007/s00345-018-2368-6
Yang SSD, Tsai YC, Chen JJ, Peng CH, Hsieh JH, Wang CC (2008) Modified transurethral incision of the bladder neck treating primary bladder neck obstruction in young men: a method to improve voiding function and to preserve antegrade ejaculation. Urol Int 80:26–30. https://doi.org/10.1159/000111725
Brant A, Cho A, Posada Calderon L, Te A, Kashanian J, Chughtai B (2020) Ejaculatory hood-sparing vaporization of the prostate and its impact on erectile, ejaculatory, and sexual function. Urology. https://doi.org/10.1016/j.urology.2020.06.072
Abolazm AE, El-Hefnawy AS, Laymon M, Shehab-El-Din AB, Elshal AM (2020) Ejaculatory hood sparing versus standard laser photoselective vaporization of the prostate: sexual and urodynamic assessment through a double blinded, randomized trial. J Urol 203:792–801. https://doi.org/10.1097/JU.0000000000000685
Contreras PN, Bonanno N, Rios Pita H, Villasante N, Ameri C, Blas L (2020) Antegrade ejaculation preservation technique with greenlight XPS 180-W: functional ejaculatory results. J Endourol. https://doi.org/10.1089/end.2020.0264
Huet R, Peyronnet B, Khene ZE, Freton L, Verhoest G, Manunta A, Bensalah K, Vincendeau S, Mathieu R (2019) Prospective assessment of the sexual function after greenlight endoscopic enucleation and greenlight 180w xps photoselective vaporization of the prostate. Urology 131:184–189. https://doi.org/10.1016/j.urology.2019.06.020
Thomas JA, Tubaro A, Barber N et al (2016) A multicenter randomized noninferiority trial comparing GreenLight-XPS laser vaporization of the prostate and transurethral resection of the prostate for the treatment of benign prostatic obstruction: two-yr outcomes of the GOLIATH study. Eur Urol 69:94–102. https://doi.org/10.1016/j.eururo.2015.07.054
Chung DE, Wysock JS, Lee RK, Melamed SR, Kaplan SA, Te AE (2011) Outcomes and complications after 532 nm laser prostatectomy in anticoagulated patients with benign prostatic hyperplasia. J Urol 186:977–981. https://doi.org/10.1016/j.juro.2011.04.068
Rieken M, Antunes-Lopes T, Geavlete B, Marcelissen T (2018) What is new with sexual side effects after transurethral male lower urinary tract symptom surgery? Eur Urol Focus 4:43–45. https://doi.org/10.1016/j.euf.2018.05.001
McVary KT, Rogers T, Roehrborn CG (2019) Rezūm water vapor thermal therapy for lower urinary tract symptoms associated with benign prostatic hyperplasia: 4-year results from randomized controlled study. Urology 126:171–179. https://doi.org/10.1016/j.urology.2018.12.041
Sadri I, Arezki A, Couture F et al (2020) Reasons to overthrow TURP: bring on Aquablation. World J Urol. https://doi.org/10.1007/s00345-020-03390-x
Funding
No funding was received for conducting this study.
Author information
Authors and Affiliations
Contributions
Surgical technique development and manuscript editing: PD and PG. Manuscript writing: MS and FS. Data collection: MS, EV, FV, AB, AB, and BL.
Corresponding author
Ethics declarations
Conflict of interest
Destefanis Paolo: Dr. Destefanis carried out retributed tutoring activities for DBI Italy (GreenLight® tutoring program); Sibona Mattia, Soria Francesco, Vercelli Eugenia, Vitiello Federico, Bisconti Alessandro, Bosio Andrea, Lillaz Beatrice and Gontero Paolo have no conflicts of interest to disclose.
Ethical approval
The IRB approval (retrospective studies) was obtained. The study was conducted accordingly to the principles of the Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
All patients signed an informed consent before surgery.
Consent to publication
All patients gave their consent for the publication of this article.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Destefanis, P., Sibona, M., Soria, F. et al. Ejaculation-sparing versus non-ejaculation-sparing anatomic GreenLight laser enucleo-vaporization of the prostate: first comparative study. World J Urol 39, 3455–3463 (2021). https://doi.org/10.1007/s00345-021-03615-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-021-03615-7