Objective: To evaluate the effects of holmium laser enucleation of the prostate (HoLEP) on sexual function.
Methods: A retrospective analysis of 202 sexually active patients who underwent HoLEP was performed. Patients were assessed at baseline and three and 12 months post-HoLEP. Evaluations included uroflowmetry and symptom questionnaires (IIEF-5, ICIQ-MLUTSsex, AUA-SS, and QoL score). Non-parametric, Fisher's exact, and chi-squared tests were used to assess changes from baseline and to identify risk factors, if any, associated with deterioration of sexual function after surgery.
Results: No significant differences were found between the preoperative and postoperative scores on the questionnaires that evaluated erection quality. However, 6.9% and 12.4% of the patients reported an increase or a reduction, respectively, of greater than five points in total IIEF-5 score. The reduction in IIEF-5 score was statistically significant only in the subgroup of patients without preoperative erectile dysfunction (ED). No preoperative characteristics and no parameters related to the surgery or postoperative outcome were significantly associated with the impairment of erection quality after surgery. In fact, neither capsular perforation nor the total laser energy used during the procedure affected erections. Loss of antegrade ejaculation was found in 70.3% of patients, while 21% reported a reduction in semen quantity. However, concern regarding ED or ejaculatory dysfunctions decreased with surgery.
Conclusions: Although erectile function was not altered in the vast majority of patients after HoLEP, patients without preoperative ED displayed a relatively small, but still significant, negative effect on erections. The overwhelming majority of patients suffered from retrograde ejaculation after surgery.
Written by:
Placer J, Salvador C, Planas J, Trilla E, Lorente D, Celma A, López MA, Morote J. Are you the author?
Hospital Vall d'Hebron, Urology, Passeig Vall d'Hebron 119-129, Barcelona, Spain.
Reference: J Endourol. 2014 Aug 18. Epub ahead of print.
doi: 10.1089/end.2014.0502
PubMed Abstract
PMID: 25133981