The impact of surgical treatments for lower urinary tract symptoms/benign prostatic hyperplasia on male erectile function: A systematic review and network meta-analysis

The aim of this study was to compare the clinical outcomes between thulium laser enucleation of the prostate (ThuLEP) and plasmakinetic bipolar resection of the prostate (PKRP) for treating benign prostatic hyperplasia (BPH) in a prospective randomized trial with 5 years of follow-up. One hundred fifty-eight consecutive patients with BPH were randomized to receive operation of either ThuLEP (n = 79) or PKRP (n = 79). All cases were evaluated preoperatively, and a part of them were evaluated at 3–5 years postoperatively by the International Prostate Symptom Score (IPSS), quality of life score (QoLS), maximum flow rate (Q
 max), and postvoid residual (PVR) urine volume. Eighty patients completed the 5-year follow-up. Each study arm showed no significant difference in preoperative parameters. Compared with PKRP, ThuLEP required longer operation time (65.4 vs 47.4 min, p = 0.022) but resulted in less hemoglobin decrease (1.5 vs 3.0 g/L, p = 0.045), catheterization time (2.1 vs 3.5 days, p = 0.031), irrigated volume (12.4 vs 27.2 L, p = 0.022), and hospital stay (2.5 vs 4.6 days, p = 0.026). During the 60-month follow-up, both procedures demonstrated no significant difference in terms of Q
 max, IPSS, PVR urine volume, and QoLS. ThuLEP was statistically superior to PKRP in blood loss, catheterization time, irrigated volume, and hospital stay but inferior to PKRP in operation time. However, both procedures showed no significant difference in terms of Q
 max, IPSS, PVR urine volume, and QoLS through the 60-month follow-up.

Comparison of thulium laser enucleation and plasmakinetic resection of the prostate in a randomized prospective trial with 5-year follow-up.

State of the Art of Thulium Laser Enucleation and Vapoenucleation of the Prostate: A Systematic Review.

Purpose of reviewThere is increasing interest among men who require benign prostatic obstruction (BPO) surgery for treatment, which also preserves sexual function. Transurethral resection of the prostate (TURP) impacts sexual function; some novel treatments claim to preserve it. Concerns exist among

Preservation of sexual function when relieving benign prostatic obstruction surgically: can a trade-off be considered?

Several sexual side effects, including erectile, ejaculatory, and orgasmic dysfunction, were reported with the majority of surgical procedures for benign prostatic obstruction (BPO).To systematically review current evidence regarding the impact of benign prostatic hyperplasia (BPH) surgery on sexual function.A comprehensive bibliographic search on the MEDLINE, Cochrane Library, Embase, Web of Science, and Google Scholar databases was conducted in July 2021. The population, intervention, comparator, and outcome (PICO) model was used to define study eligibility. Studies were Included if they assessed patients with BPO and related lower urinary tract symptoms (P) undergoing BPH surgery (I) with or without a comparison between surgical treatments (C) evaluating the impact on sexual function (O). Retrospective and prospective primary studies were included. A pooled analysis was conducted on studies including the postoperative assessment of International Index of Erectile Function (IIEF)-5, Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD; Function and/or Bother), or retrograde ejaculation (RE) rate (PROSPERO database ID: CRD42020177907).A total of 151 studies investigating 20 531 patients were included. Forty-eight randomized controlled trials evaluating 5045 individuals were eligible for the meta-analysis. In most studies (122, 80.8%), only erectile and/or ejaculatory function was evaluated. A substantial number of articles (67, 44.4%) also used nonvalidated tools to evaluate erectile and/or ejaculatory function. The pooled analysis showed no statistically significant changes in IIEF-5 score compared with baseline for the transurethral resection of the prostate (TURP; weighted mean difference [WMD] 0.76 pts; 95% confidence interval [CI] -0.1, 1.62; p = 0.08), laser procedure (WMD 0.33 pts; 95% CI -0.1, 0.77; p = 0.13), and minimally invasive treatment (WMD -1.37 pts; 95% CI -3.19, 0.44; p = 0.14) groups. A statistically significantly higher rate of RE was found after TURP (risk ratio [RR] 13.31; 95% CI 8.37, 21.17; p < 0.00001), other electrosurgical procedures (RR 34.77; 95% CI 10.58, 127.82; p < 0.00001), and the entire laser group (RR 17.37; 95% CI 5.93, 50.81; p < 0.00001). No statistically significant increase in RE rate was described after most of the minimally invasive procedures (p > 0.05). The pooled analysis of MSHQ-EjD scores was possible only for prostatic urethral lift, showing no statistically significant difference between baseline and post-treatment MSHQ-EjD Function scores (WMD -0.80 pts; 95% CI -2.41, 0.81; p = 0.33), but postoperative MSHQ-EjD Bother scores were significantly higher (WMD 0.76 pts; 95% CI 0.22, 1.30; p = 0.006).Erectile function appears to be unaffected by most surgical procedures for BPO. RE is a very common adverse event of BPH surgery, although emerging minimally invasive surgical procedures could be associated with a lower risk.Benign prostatic hyperplasia surgery can have an impact on sexual function, mainly involving ejaculatory function. 

Impact of Surgery for Benign Prostatic Hyperplasia on Sexual Function: A Systematic Review and Meta-analysis of Erectile Function and Ejaculatory Function.

The objective of this work is to evaluate the impact of 120-W 2-μm continuous wave (cw) laser vapoenucleation of the prostate in patients with benign prostatic hyperplasia (BPH) on sexual function. One hundred twenty-two consecutive patients with BPH were retrospectively collected in this study and were classified into two groups for surgical treatment with 2-μm cw laser vapoenucleation or transurethral resection of the prostate (TURP). International Index of Erectile Function (IIEF) and general assessment questions were completed before and 12 months after treatment to determine the impact on sexual function. A total of 33 patients (52.4 %) in group 1 and 31 (52.5 %) in group 2 reported various degrees of erectile dysfunction before surgery. Interestingly, an increase in IIEF-EF score by 2 points was reported by 16 (25.4 %) and 14 (23.7 %) patients, respectively, and mean EF score did show a marginal but not significant increase postoperatively in both group. Differences about orgasmic intercourse satisfaction, sexual desire domain, and overall satisfaction scores in each group were not significant between preoperative and postoperative, but there was a significant decrease in the orgasmic function domain score at 12 months postoperation in both groups (p < 0.001). The prevalence of postoperative retrograde ejaculation was significantly higher than at baseline assessment in two groups. This study demonstrates that there is no difference between 2 μm laser vapoenucleation and TURP in terms of impact on sexual function. No significant erectile function improvement was observed after surgery, but these two techniques significantly lowered the IIEF orgasmic function domain and this was mainly caused by retrograde ejaculation.

Impact of 120-W 2-μm continuous wave laser vapoenucleation of the prostate on sexual function

Purpose A palatal fistula following the closure of palatal clefts remains a difficult clinical complication. Surgical treatment of fistulas is often complicated, with high recurrence rates. We present our results of fistula closure augmented with GTR, a resorbable membrane designed to promote guided tissue regeneration. Methods We reviewed the records of 75 patients operated on between 2008 and 2022 for closure of the palatal fistula. The patients included 24 who underwent fistula closure augmented with GTR and 51 who underwent fistula closure with other techniques. We reviewed the age at surgery, sex, fistula location, and outcome. Operation success was defined as an asymptomatic patient with a healed fistula on clinical examination. Results The overall fistula closure rate was 79.1% in the GTR group and 76.5% in the non-GTR group(p = 0.79). Discussion The success rate of fistula closure in the GTR group is comparable to that in the non-GTR group in this study. An additional advantage is that this procedure does not require harvesting any autologous tissue and reduces tissue damage in the long term.

/pdf/evaluation-of-the-effect-of-a-resorbable-membrane-on-the-17s74sv9.pdf

Evaluation of the effect of a resorbable membrane on the closure of palatal fistulas

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Impact of 120-W 2-μm continuous wave laser vapoenucleation of the prostate on sexual function

Evaluation of the effect of a resorbable membrane on the closure of palatal fistulas