Ejaculation-sparing thulium laser enucleation of the prostate (ES-ThuLEP): outcomes on a large cohort
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ORIGINAL ARTICLE
Ejaculation‑sparing thulium laser enucleation of the prostate (ES‑ThuLEP): outcomes on a large cohort Giorgio Bozzini1 · Lorenzo Berti1,2 · Matteo Maltagliati1,2 · Umberto Besana1 · Alberto Calori1 · Alexander Müller3 · Maria Chiara Sighinolfi2 · Salvatore Micali2 · Antonio Luigi Pastore4 · Rodrigo Ledezma5 · Paolo Broggini6 · Bernardo Rocco2 · Carlo Buizza1 Received: 22 June 2020 / Accepted: 5 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
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. Keywords Ejaculation · Ejaculatory dysfunction · Ejaculation sparing · Benign prostatic hyperplasia · Lower urinary tract symptoms · Thulium laser · ThuLEP · Endoscopic enucleation of the prostate
Introduction * Giorgio Bozzini [email protected] 1
Department of Urology, ASST Valle Olona, Ospedale di Busto Arsizio (VA), Busto Arsizio, Italy
2
Department of Urology, Università degli Studi di Modena e Reggio Emilia (MO), Modena, Italy
3
Department of Urology, Spital Limmattal, Schlieren, Switzerland
4
Department of Urology, Sapienza Università di Roma, Latina, Italy
5
Department of Urology, Hospital Clìnico Universidad de Chile, Santiago, Chile
6
Department of Urology, Clinica Sant’Anna, Lugano, Switzerland
Benign prostatic hyp
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