A Systematic Review of Reported Ejaculatory Dysfunction in Clinical Trials Evaluating Minimally Invasive Treatment Modal
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BENIGN PROSTATIC HYPERPLASIA (K MCVARY, SECTION EDITOR)
A Systematic Review of Reported Ejaculatory Dysfunction in Clinical Trials Evaluating Minimally Invasive Treatment Modalities for BPH Soum D. Lokeshwar 1 & David Valancy 2 & Thiago Fernandes Negris Lima 2 & Ruben Blachman-Braun 2 & Ranjith Ramasamy 2 Accepted: 15 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review To explore the sexual outcomes following the novel minimally invasive surgical procedures for benign prostatic hyperplasia- (BPH-) related lower urinary tract symptoms (LUTS), with an emphasis on ejaculatory dysfunction (EjD). Recent Findings A database search with a 10-year time restriction was carried out until February 20, 2020 using MEDLINE through the PubMed Platform evaluating minimally invasive treatment modalities for BPH and their effect on EjD. After the article selection, we retrieved data for men randomized in 19 different studies with results in 40 separate published articles investigating minimally invasive BPH surgery and reporting EjD rates. To date, water vapor thermal therapy or Rezūm, prostatic urethral lift (PUL) or UroLift®, prostate artery embolization (PAE), and Aquablation showed acceptable rates (< 2%) of retrograde ejaculation by 1 year and had very low adverse events related to the procedure. Both PUL and Rezūm demonstrated lower rates when compared with PAE and Aquablation. Summary With comparable sexual side effect profiles postoperatively, clinicians may determine which therapeutic modality is optimal for patients based on efficacy and cost-benefit. Further randomized clinical trials are required to directly compare the effect of novel minimally invasive surgical procedures for BPH-related LUTS on ejaculation and sexual function. Keywords Ejaculatory dysfunction . Benign prostatic hyperplasia . Water vapor thermal therapy . Prostatic urethral lift . Prostate artery embolization . Aquablation
Introduction Benign prostatic hyperplasia (BPH) is a benign proliferation of the tissue in the transition zone of the prostate. The prevalence of BPH increases with age with autopsy studies showing histological prevalences of 8, 50, and 80% in the fourth, sixth, and ninth decades of life, respectively [1, 2]. The gold standard treatment of BPH is the This article is part of the Topical Collection on Benign Prostatic Hyperplasia Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s11934-02001012-y. * Ranjith Ramasamy [email protected] 1
Department of Urology, Yale Univeristy School of Medicine, 333 Cedar Street, New Haven, CT 06520-8058, USA
2
Department of Urology, Miller School of Medicine, University of Miami, 1120 NW 14th Street, 15th Floor, Miami, FL 33136, USA
transurethral resection of the prostate (TURP). Unfortunately, men who undergo TURP have considerable sexual dysfunction, including retrograde ejaculation (RE). Up to 66.1% of men who undergo TURP report RE [3]. RE will also affect three out of fou
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