Ejaculatory Hood-Sparing Vaporization of the Prostate and its Impact on Erectile, Ejaculatory, and Sexual Function - Beyond the Abstract

Transurethral resection of the prostate (TURP), which is the gold standard treatment for men with benign prostatic hyperplasia (BPH) who fail medical management, is associated with ejaculatory dysfunction and more rarely erectile dysfunction. To mitigate the sexual side effects of TURP, we describe a modified technique to preserve the ejaculatory hood of the prostate. In this prospective study, we found that patients who underwent ejaculatory hood (EH)-sparing transurethral vaporization of the prostate (TUVP) reported high rates of anterograde ejaculation, and based on Men’s Sexual Health Questionnaire (MSHQ) surveys, reported improvements in overall sexual function and erectile function as well.

25 patients participated in the study from 2016 to 2018. Men underwent either photo vaporization of the prostate with greenlight laser or bipolar button plasma vaporization of the prostate. Participants completed MSHQ surveys prior to surgery and at 1 and 3 months after surgery. 80% of men reported preserved anterograde ejaculation, and 72% of men reported improvements in overall MSHQ score at 3-months postoperatively. The median scores for the domains of ejaculatory function and erectile function were also significantly improved at 3 months. Using a multivariate regression, we found that patients with more severe pre-operative AUA symptoms scores were more likely to have improvements in total MSHQ scores.

This study validates the use of EH-sparing TUVP as a viable option in patients with BPH-related LUTS who wish to preserve their sexual function, and adds to the existing literature on the interplay between LUTS and sexual dysfunction. Prior research has shown an association between severity of LUTS and severity of sexual dysfunction,1 and certain therapies, such as tadalafil, are associated with improvements in both disorders.2 We demonstrated that men with BPH, particularly those with more severe LUTS, may have improvements in both micturition and sexual function after EH-sparing TUVP.

Written by: Aaron Brant, MD, Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA, and Bilal Chughtai, MD, Department of Urology, Weill Cornell Medical College/New York-Presbyterian, New York, NY. 

References: 

  1. Namasivayam S, Minhas S, Brooke J, et al. “The Evaluation of Sexual Function in Men Presenting with Symptomatic Benign Prostatic Hyperplasia.” BJU International, vol. 82, no. 6, 1998, pp. 842–846., doi:10.1046/j.1464-410x.1998.00868.x.
  2. McVary KT, Roehrborn CG, Kaminetsky JC, et al. "Tadalafil relieves lower urinary tract symptoms secondary to benign prostatic hyperplasia." J Urol. 2007;177(4):1401–7.
Read the Abstract
email news signup