Elsevier

Urology

Volume 80, Issue 5, November 2012, Pages 1098-1104
Urology

Prostatic Diseases and Male Voiding Dysfunction
Male Sexual Function Outcome After Three Laser Prostate Surgical Techniques: A Single Center Perspective

https://doi.org/10.1016/j.urology.2012.08.001Get rights and content

Objective

To assess the change and predictors of sexual-related outcomes after laser prostate surgery.

Methods

This is a longitudinal study of 216 sexually active men who underwent laser prostatectomy between 2005 and 2010. The International Index of Erectile Function-15 questionnaire was used both preoperatively and during the first year of follow-up. Cases with unreliable answers or patients without interested partners were excluded. All relevant data of both groups were depicted and statistically analyzed.

Results

We identified 191 patients that met the inclusion criteria, 99 holmium laser enucleation of the prostate, 34 holmium laser ablation, and 58 photoselective vaporization of the prostate (GreenLight-532-mm laser photoselective vaporization of the prostate). There were significant differences among the 3 groups regarding the International Index of Erectile Function-15 direction of change at 1 year, being unchanged in (22.2%, 24.4%, and 29.3%), improved in (60.6%, 29.4%, and 41.4), and declined in (17.2%, 41.2%, and 29.3%) in the 3 groups, respectively (P < .05). After adjusting for clinical and perioperative variables, the independent risk factors for decline in the International Index of Erectile Function score were basal International Index of Erectile Function ≥55 and energy to prostate ratio. In holmium laser enucleation of the prostate group, there was significant improvement of the mean overall score, erectile function, desire, and intercourse satisfaction domains (P < .05). In holmium laser ablation and photoselective vaporization of the prostate groups, there were no significant changes between mean preopeative and postoperative scores (P > .05). The incidence of new onset retrograde ejaculation in the holmium laser enucleation of the prostate group was (77.3%) significantly different compared to (31.1%) in the holmium laser ablation group and (33.2%) in photoselective vaporization of the prostate group (P < .05).

Conclusion

Laser prostate surgery using more size-related laser energy might have possible negative influence on sexual function. Patients with normal preoperative sexuality are more at risk.

Section snippets

Study Design

By March 2005, all sexually active men who were candidates for laser prostate surgery were asked to fill out the International Index of Erectile Function (IIEF)-15 questionnaire13 before surgery, 6 months, and 1 year postoperative. All patients' data were prospectively maintained in the prostate unit database.

In this study, we reviewed the prostate unit database for patients who underwent laser prostate surgery between March 2005 and October 2010 and identified patients who completed the

Patients' Follow-Up and Assessment

All patients underwent preoperative evaluation, including the International Prostate Symptom Score (IPSS), quality of life (QOL) score, IIEF-15, uroflowmetry, prostatic-specific antigen (PSA,) and transrectal ultrasound (TRUS) for prostatic volume. Patients were followed at 1, 6, and 12 months. The follow-up assessment included IPSS, QOL, IIEF-15, uroflowmetry, PSA, and specific questions targeting the ejaculatory process (absent, retrograde, or antegrade with or without pain on ejaculation).

Demographic and Perioperative Data

The 3 laser groups were comparable regarding age at time of surgery (mean of 68.1 years), indications of surgery, associated diabetes mellitus, and baseline subjective and objective urine flow parameters. Mean preoperative IIEF-15 score was not significantly different in the 3 groups; however, significantly more patients with normal preoperative IIEF-15 scores (≥55) were present in the HOLAP group.

No significant difference was found among the 3 groups regarding intraoperative total laser energy

Comment

Proper preoperative counseling for patients who are going to have laser prostate surgery remains an unanswered question in the urologic literature. In fact, it is a 2-sided equation, whereas on 1 side, the successful prostate surgery with subsequent relief of LUTs and discontinuation of prostate medications (retrograde ejaculation/an ejaculation with alpha blockers or ED with 5 alpha-reductase inhibitors), all are in favor of improvement of sexual function.4, 6 The flip side of the coin is

Conclusions

Prostate laser ablation techniques have required more size-related laser energy, which might influence sexual function. Laser enucleation techniques are associated with ejaculatory dysfunction with possible reduction in orgasmic perception. The negative impact of these procedures on male sexual function is more pronounced in patients with normal preoperative sexual function.

The shortcoming of the IIEF-15 in the assessment of the impact of ejaculatory patterns on overall patient satisfaction in

Acknowledgments

The authors thank Dr. Yitzchak (Irv) Binik, Ph.D. for his study advice and review of the article.

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    Financial Disclosure: Mostafa M. Elhilali is a consultant to Lumenis and Laserscope, the other authors have no conflict of interest to declare.

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