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Open Access 01-10-2020 | Ejaculatory Disorder | Original Article

Ejaculatory disorders after prostatic artery embolization: a reassessment of two prospective clinical trials

Authors: Gautier Müllhaupt, Lukas Hechelhammer, Pierre-André Diener, Daniel S. Engeler, Sabine Güsewell, Hans-Peter Schmid, Livio Mordasini, Dominik Abt

Published in: World Journal of Urology | Issue 10/2020

Abstract

Purpose

This study aims to specify and explain the previous findings of unexpectedly high rates of ejaculatory disorders, i.e. 56%, found after prostatic artery embolization (PAE) in a randomized controlled trial comparing safety and efficacy of PAE and transurethral resection of the prostate (TURP).

Patients and methods

Case report forms of the randomized controlled trial were analyzed to specify the grade of postoperative ejaculatory dysfunction 3 months postoperatively.

In addition, study participants with assessable ejaculation were asked to complete the four-item Male Sexual Health Questionnaire-Ejaculation Dysfunction Short Form (MSHQ-EjD) referring to their ejaculatory function at present, as well as before treatment and 3 months after. Potential explanations for ejaculatory disorders after PAE were derived from histological examination of five radical prostatectomy specimens of patients that underwent PAE 6 weeks before radical prostatectomy within a proof-of-concept trial at the study site, St. Gallen Cantonal Hospital. An experienced uropathologist systematically examined the whole-gland embedded tissue with focus on structures that are involved into ejaculation.

Results

While patients after TURP predominantly suffered from anejaculation (52%), diminished ejaculation was found more often after PAE (40%). Significantly higher MSHQ-EjD scores were found 3 months after PAE and at a median follow-up of 31 months.

Histological examination showed marked changes of structures involved into ejaculation (e.g., prostatic glands, seminal vesicles, ejaculatory ducts) after PAE.

Conclusion

Although anejaculation occurs less frequently after PAE (16%) compared to TURP (52%), patients have to be informed about the relevant risk of ejaculatory disorders, especially diminished ejaculation.

Lebdai S, Chevrot A, Doizi S, Pradere B, Delongchamps NB, Benchikh A, Cornu JN, Della Negra E, Fourmarier M, Misrai V, Theveniaud PE, Descazeaud A, Robert G, CTMH-AFU Group (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):299–308. https://doi.org/10.1007/s00345-018-2368-6(epub 2018 Jul 2)CrossRefPubMed

Shim SR, Kanhai KJ, Ko YM, Kim JH (2017) Efficacy and safety of prostatic arterial embolization: systematic review with meta-analysis and meta-regression. J Urol 197(2):465–479. https://doi.org/10.1016/j.juro.2016.08.100CrossRefPubMed

Ray AF, Powell J, Speakman MJ, Longford NT, DasGupta R, Bryant T, Modi S, Dyer J, Harris M, Carolan-Rees G, Hacking N (2018) Efficacy and safety of prostate artery embolization for benign prostatic hyperplasia: an observational study and propensity-matched comparison with transurethral resection of the prostate (the UK-ROPE study). BJU Int 122(2):270–282. https://doi.org/10.1111/bju.14249CrossRefPubMed

Abt D, Hechelhammer L, Mullhaupt G, Markart S, Gusewell S, Kessler TM, Schmid HP, Engeler DS, Mordasini L (2018) Comparison of prostatic artery embolisation (PAE) versus transurethral resection of the prostate (TURP) for benign prostatic hyperplasia: randomised, open label, non-inferiority trial. BMJ 361:k2338. https://doi.org/10.1136/bmj.k2338CrossRefPubMedPubMedCentral

National Cancer Institute (NCI) common terminology criteria for adverse events (CTCAE) version 4.0. https://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03/CTCAE_4.03_2010-06-14_QuickReference_5x7.pdf

Mordasini L, Hechelhammer L, Diener PA, Diebold J, Mattei A, Engeler D, Mullhaupt G, Kim SK, Schmid HP, Abt D (2018) Prostatic artery embolization in the treatment of localized prostate cancer: a bicentric prospective proof-of-concept study of 12 patients. J Vasc Interv Radiol 29(5):589–597. https://doi.org/10.1016/j.jvir.2018.01.766CrossRefPubMed

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(5):805–809. https://doi.org/10.1016/j.urology.2007.02.036CrossRefPubMed

Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB (1994) Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 151(1):54–61CrossRef

Kim JK, Cho MC, Son H, Ku JH, Oh SJ, Paick JS (2017) Patient perception of ejaculatory volume reduction after holmium laser enucleation of the prostate (HoLEP). Urology 99:142–147. https://doi.org/10.1016/j.urology.2016.09.037CrossRefPubMed

Title: Ejaculatory disorders after prostatic artery embolization: a reassessment of two prospective clinical trials
Authors: Gautier Müllhaupt
Lukas Hechelhammer
Pierre-André Diener
Daniel S. Engeler
Sabine Güsewell
Hans-Peter Schmid
Livio Mordasini
Dominik Abt
Publication date: 01-10-2020
Publisher: Springer Berlin Heidelberg
Keywords: Ejaculatory Disorder
Benign Prostatic Hypertrophy
Prostatectomy
Benign Prostatic Hypertrophy
Transurethral Prostate Resection
Prostatectomy
Published in: World Journal of Urology / Issue 10/2020
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-019-03036-7

At a glance: The STEP trials

Springer Medicine

Ejaculatory disorders after prostatic artery embolization: a reassessment of two prospective clinical trials

Abstract

Purpose

Patients and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Patients and methods

Results

Conclusion

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