Ejaculatory disorders after prostatic artery embolization: a reassessment of two prospective clinical trials
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ORIGINAL ARTICLE
Ejaculatory disorders after prostatic artery embolization: a reassessment of two prospective clinical trials Gautier Müllhaupt1 · Lukas Hechelhammer2 · Pierre‑André Diener4 · Daniel S. Engeler1 · Sabine Güsewell3 · Hans‑Peter Schmid1 · Livio Mordasini1 · Dominik Abt1 Received: 18 May 2019 / Accepted: 21 November 2019 © The Author(s) 2019
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. Keywords Anejaculation · Benign prostatic hyperplasia · Diminished ejaculation · Ejaculatory disorders · Prostatic artery embolization · Retrograde ejaculation
Introduction
* Gautier Müllhaupt [email protected] 1
Department of Urology, St. Gallen Cantonal Hospital, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland
2
Department of Radiology and Nuclear Medicine, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
3
Clinical Trials Unit, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
4
Department of Pathology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
Preservation of ejaculatory function is an important issue for many patients undergoing surgery for lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH/LUTS). Reliable preservation of ejaculation is, however, hardly possible with most surgical opt
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