Top

Published in:

01-06-2021 | Benign Prostatic Hypertrophy | Original Article

Ejaculation-sparing thulium laser enucleation of the prostate (ES-ThuLEP): outcomes on a large cohort

Authors: Giorgio Bozzini, Lorenzo Berti, Matteo Maltagliati, Umberto Besana, Alberto Calori, Alexander Müller, Maria Chiara Sighinolfi, Salvatore Micali, Antonio Luigi Pastore, Rodrigo Ledezma, Paolo Broggini, Bernardo Rocco, Carlo Buizza

Published in: World Journal of Urology | Issue 6/2021

Abstract

Purpose

To assess the effects of a new ejaculation-sparing thulium laser enucleation of the prostate (ES-ThuLEP) technique on sexual functions and micturition, in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) and to evaluate how the surgical technique of ES-ThuLEP can lead to ejaculation preservation.

Methods

A prospective study was carried out between January 2015 and January 2018 on patients with surgical indication for BPH, who wished to preserve ejaculation. The patients were treated with ES-ThuLEP and were evaluated before and 3 and 6 months after surgery. Three validated questionnaires (ICIQ-MLUTSsex, IIEF-5 and IPSS) were used to assess changes in ejaculation, erectile function and urinary symptoms. Uroflowmetry (Qmax and Qavg), post-void residual volume and voided volume were also evaluated, to assess micturition improvement. Patients with moderate to severe erectile dysfunction were excluded. Statistical analysis was performed with the Student’s t test, Chi-square test and logistic regression analysis.

Results

Two hundred and eighty three patients were enrolled. Ejaculation was spared in 203 and 219 patients at 3 and 6 months after surgery. No significant differences were observed between erectile function before and after surgery: baseline IIEF-5 = 16.2 ± 4.47 vs 16.7 ± 2.9 (p = 0.419) and 17.7 ± 3.2 (p = 0.410) at 3 and 6 months. Significant improvement in urinary symptoms was achieved: baseline IPSS = 19.4 ± 7.24 vs 5.8 ± 4.3 (p = 0.032) and 3.9 ± 4.1 (p = 0.029) at 3 and 6 months.

Conclusion

ES-ThuLEP effectively preserved ejaculation in over two thirds of the patients without compromising micturition improvement or erectile function. ES-ThuLEP could be a valid treatment option for BPH in young and sexually active men.

Lee SWH, Chan EMC, Lai YK (2017) The global burden of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a systematic review and meta-analysis. Sci Rep 7(1):7984CrossRef

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):637–649CrossRef

Naspro R, Gomez Sancha F, Manica M et al (2017) From “gold standard” resection to reproducible “future standard” endoscopic enucleation of the prostate: what we know about anatomical enucleation. Minerva Urol Nefrol 69(5):446–458PubMed

Herrmann TR (2016) Enucleation is enucleation is enucleation is enucleation. World J Urol 34(10):1353–1355CrossRef

Gilling PJ, Kennett K, Das AK et al (1998) Holmium laser enucleation of the prostate (HoLEP) combined with transurethral tissue morcellation: an update on the early clinical experience. J Endourol 12(5):457–459CrossRef

Herrmann TR, Bach T, Imkamp F et al (2010) Thulium laser enucleation of the prostate (ThuLEP): transurethral anatomical prostatectomy with laser support. Introduction of a novel technique for the treatment of benign prostatic obstruction. World J Urol 28(1):45–51CrossRef

Bozzini G, Seveso M, Melegari S et al (2017) Thulium laser enucleation (ThuLEP) versus transurethral resection of the prostate in saline (TURis): a randomized prospective trial to compare intra and early postoperative outcomes. Actas Urol Esp 41(5):309–315CrossRef

Sun F, Sun X, Shi Q et al (2018) Transurethral procedures in the treatment of benign prostatic hyperplasia: a systematic review and meta-analysis of effectiveness and complications. Medicine (Baltimore) 97(51):e13360CrossRef

Lin Y, Wu X, Xu A et al (2016) Transurethral enucleation of the prostate versus transvesical open prostatectomy for large benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials. World J Urol 34(9):1207–1219CrossRef

10.

Zhang J, Ou Z, Zhang X et al (2019) Holmium laser enucleation of the prostate versus thulium laser enucleation of the prostate for the treatment of large-volume prostates > 80 ml: 18-month follow-up results. World J Urol. https://doi.org/10.1007/s00345-019-02945-xCrossRefPubMedPubMedCentral

11.

Gravas S, Cornu JN, Gacci M et al (2019) EAU guidelines on management of non-neurogenic male lower urinary tract symptoms (LUTS) incl. benign prostatic obstruction (BPO). EAU Guidelines Office, Arnhem, The Netherlands. https://uroweb.org/guideline/treatment-of-non-neurogenic-male-luts/

12.

DeLay KJ, Nutt M, McVary KT (2016) Ejaculatory dysfunction in the treatment of lower urinary tract symptoms. Transl Androl Urol 5(4):450–459CrossRef

13.

Marra G, Sturch P, Oderda M et al (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(1):22–35CrossRef

14.

Woo HH, Bolton DM, Laborde E et al (2012) Preservation of sexual function with the prostatic urethral lift: a novel treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Sex Med 9(2):568–575CrossRef

15.

Albisinni S, Aoun F, Roumeguère T et al (2017) New treatment strategies for benign prostatic hyperplasia in the frail elderly population: a systematic review. Minerva Urol Nefrol 69(2):119–132PubMed

16.

Gratzke C, Barber N, Speakman MJ et al (2017) Prostatic urethral lift vs transurethral resection of the prostate: 2-year results of the BPH6 prospective, multicentre, randomized study. BJU Int 119(5):767–775CrossRef

17.

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(2):299–308CrossRef

18.

Marberger H (1974) The mechanisms of ejaculation. Basic Life Sci 4(PT. B):99–110PubMed

19.

Gallizia P (1972) The smooth sphincter of the vesical neck, a genital organ. Urol Int 27(4):341–354CrossRef

20.

Sturch P, Woo HH, McNicholas T et al (2015) Ejaculatory dysfunction after treatment for lower urinary tract symptoms: retrograde ejaculation or retrograde thinking? BJU Int 115(2):186–187CrossRef

21.

Gil-Vernet JM Jr, Alvarez-Vijande R, Gil-Vernet A et al (1994) Ejaculation in men: a dynamic endorectal ultrasonographical study. Br J Urol 73(4):442–448CrossRef

22.

Dorschner W, Stolzenburg JU (1994) A new theory of micturition and urinary continence based on histomorphological studies. 3. The two parts of the musculus sphincter urethrae: physiological importance for continence in rest and stress. UrolInt 52(4):185–188

23.

Ronzoni G, De Vecchis M (1998) Preservation of anterograde ejaculation after transurethral resection of both the prostate and bladder neck. Br J Urol 81(6):830–833CrossRef

24.

Alloussi SH, Lang C, Eichel R et al (2014) Ejaculation-preserving transurethral resection of prostate and bladder neck: short- and long-term results of a new innovative resection technique. J Endourol 28(1):84–89CrossRef

25.

Talab SS, Santiago-Lastra YA, Bachmann A et al (2013) The impact of ejaculation-preserving photo-selective vaporization of the prostate (EP-PVP) on lower urinary tract symptoms and ejaculatory function: results of a multicenter study. J Urol 189(4):e164

26.

Vickers AJ, Sjoberg DD (2015) Guidelines for reporting of statistics in European urology. EurUrol 67:181–187

27.

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):1817–1821CrossRef

28.

Carmignani L, Bozzini G, Macchi A et al (2015) Sexual outcome of patients undergoing thulium laser enucleation of the prostate for benign prostatic hyperplasia. Asian J Androl 17(5):802–806PubMedPubMedCentral

29.

Cacciamani GE, Cuhna F, Tafuri A et al (2019) Anterograde ejaculation preservation after endoscopic treatments in patients with bladder outlet obstruction: systematic review and pooled-analysis of randomized clinical trials. Minerva Urol Nefrol 71(5):427–434CrossRef

30.

Kim M, Song SH, Ku JH et al (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(1):20–24CrossRef

31.

Gravas S, Bachmann A, Reich O et al (2011) Critical review of lasers in benign prostatic hyperplasia (BPH). BJU Int 107(7):1030–1043CrossRef

Title: Ejaculation-sparing thulium laser enucleation of the prostate (ES-ThuLEP): outcomes on a large cohort
Authors: Giorgio Bozzini
Lorenzo Berti
Matteo Maltagliati
Umberto Besana
Alberto Calori
Alexander Müller
Maria Chiara Sighinolfi
Salvatore Micali
Antonio Luigi Pastore
Rodrigo Ledezma
Paolo Broggini
Bernardo Rocco
Carlo Buizza
Publication date: 01-06-2021
Publisher: Springer Berlin Heidelberg
Keywords: Benign Prostatic Hypertrophy
Benign Prostatic Hypertrophy
Transurethral Prostate Resection
Laser
Published in: World Journal of Urology / Issue 6/2021
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-020-03442-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Ejaculation-sparing thulium laser enucleation of the prostate (ES-ThuLEP): outcomes on a large cohort

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2021

Vacuum-assisted mini-percutaneous nephrolithotomy: a new perspective in fragments clearance and intrarenal pressure control

Perioperative outcomes and safety of robotic vs open cystectomy: a systematic review and meta-analysis of 12,640 cases

Incidence and outcome of salvage cystectomy after bladder sparing therapy for muscle invasive bladder cancer: a systematic review and meta-analysis

Relevance of intravesical pressures during transurethral procedures

Perioperative and 1-year patient-reported outcomes of Freyer versus Millin versus Madigan robot-assisted simple prostatectomy

The predictive value of the prostate health index vs. multiparametric magnetic resonance imaging for prostate cancer diagnosis in prostate biopsy