Ejaculation sparing of classic and minimally invasive surgical treatments of LUTS/BPH.

The surgical landscape for Lower Urinary Tract Symptoms (LUTS) and Benign Prostatic Hyperplasia (BPH) has evolved with the introduction of Minimally Invasive Surgical Therapies (MISTs), recognizing the impact of sexual function on patients' well-being, and prioritizing ejaculation-sparing approaches.

This systematic review explored ejaculation sparing after classic endoscopic procedures and MISTs (iTind, Rezūm, Urolift, Aquablation, and TPLA) and a literature search yielded 41 studies.

While all procedures demonstrated efficacy in improving LUTS/BPH symptoms (IPSS, QoL, Qmax), a subset of studies evaluated ejaculatory function. Positive outcomes were noted, challenging the historical association of BPH surgeries with ejaculatory dysfunction. Variations in study design, patient cohorts, and limited long-term data present challenges. Notably, the lack of baseline specificity, use of alpha-blockers, and non-specific sexual function assessments underscore potential biases.

Despite limitations, the review tentatively concluded that MISTs, including iTind, Rezūm, Urolift, Aquablation, and TPLA, appear comparable in sparing ejaculation. Long-term studies are essential to validate sustainability, and comparative research should assess trade-offs between MISTs and traditional surgeries. Incorporating patient-reported outcomes and quality of life assessments will enhance future investigations, refining MISTs as standard therapeutic options for LUTS/BPH.

Prostate cancer and prostatic diseases. 2024 Apr 13 [Epub ahead of print]

Gian Maria Busetto, Riccardo Lombardo, Cosimo De Nunzio, Giuseppe Santoro, Edoardo Tocci, Nicola Schiavone, Andrea Tubaro, Giuseppe Carrieri, Steven A Kaplan, Thomas R W Herrmann

Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy. ., Department of Urology, Sapienza University of Rome, Rome, Italy., Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy., Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Department of Urology, Spital Thurgau AG, Kantonspital Frauenfeld, Frauenfeld, Switzerland.

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