To evaluate perioperative outcomes related to sexual and urinary function in patients who underwent a holmium laser enucleation of the prostate (HoLEP) with selective laser enucleation of the median lobe.
We retrospectively reviewed the first 450 HoLEP cases by a single surgeon from April 2019-March 2022. Fifty-five patients with intravesical-prostatic protrusion or high bladder neck without obstructing lateral lobes underwent selective enucleation of the median lobe of the prostate. Patients were asked to comment on whether they had retrograde ejaculation during their follow up appointment. Urinary function was assessed using the American Urological Association Symptom Score (AUASS) and subjective evaluation of urinary incontinence.
Median age of the cohort was 65 years (range: 44-91). Compared to pre-operative, there was significant improvement in mean post-operative AUASS (22.5 vs 6.9, p <0.001), mean post-operative quality of life scores (4 vs 1.2, p <0.001), and mean post-operative post void residual volumes (244.1 vs 69.3 cc, p <0.001). No patients reported stress urinary incontinence. Of the 55 patients who underwent selective enucleation of the median lobe, 40 were sexually active. Of those men, 35 reported normal ejaculation, 3 had retrograde ejaculation that was unchanged from pre-op, and 2 had new ejaculatory dysfunction.
In this case series of selective laser enucleation of the median lobe, urinary function significantly improved in short term follow-up with preservation of ejaculation in approximately 90% of men.
Urology. 2023 Jan 13 [Epub ahead of print]
Benjamin Press, Mursal Gardezi, David D Kim, Soum Lokeshwar, Syed Rahman, Michael Siev, Eric Ghiraldi, Lori Lerner, Daniel Kellner
Department of Urology, Yale School of Medicine, Yale University, New Haven, CT, USA., Yale School of Medicine, Yale University, New Haven, CT, USA., Division of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA., Division of Urology, VA Boston Healthcare System, Boston, Massachusetts, USA., Department of Urology, Yale School of Medicine, Yale University, New Haven, CT, USA. Electronic address: .