madman
Super Moderator
Abstract
Purpose To review the current data on retrograde ejaculation (RE) and ejaculatory dysfunction (EjD) after endoscopic and minimally invasive surgical treatment of benign prostatic obstruction (BPO) and, their perceived impact on the quality of life (QoL) and sexual life of patients and their partners.
Methods Narrative review of systematic reviews (SR) assessing comparative rates of RE, EjD, or erectile dysfunction (EF) was carried out. Relevant articles on the prevalence of RE, EjD, or EF and on their impact on the QoL or sexual life of patients and partners were manually selected based on relevance.
Results Twelve SRs reporting on comparisons of different endoscopic/minimally invasive treatments of BPO were found. Data on outcomes varied widely. Overall, after conventional TURP or laser techniques 42–75% of patients present RE. Prostatic incision and ablative procedures present the lowest rates of de novo RE or EjD whereas laser adenomectomy and ejaculation preservation procedures preserve antegrade ejaculation in 46–68% of patients. EjDs are associated with LUTS and present in 10% of sexually active men before intervention. It modulates the QoL and sexual life of the couple. In spite of the scarce literature assessing patient’s and partner’s perceptions of postoperative EjD, it strongly suggests that both parties value the maintenance of the ejaculatory function.
Conclusion Ejaculation-preserving techniques and minimally invasive techniques successfully prevent BPO treatment-induced RE or EjD in 70–100% of the cases. While this is appealing to patients and spouses, technique selection and treatment durability are issues to be discussed with the couple.
Introduction
It is estimated that around half of men suffering severe or medical treatment unresponsive lower urinary tract symptoms (LUTS) will be offered a surgical procedure to relieve benign prostatic obstruction (BPO) [1]. When surgery is indicated, transurethral resection and incision of the prostate (TURP, TUIP) remain the cornerstone for glands>30 mL and < 30 mL, respectively [2]. Whilst efficacy of the conventional TURP is proven, a common potentially bothersome side effects, retrograde ejaculation (RE) occurs in 65.4–86% of the sexually active patients [3, 4].
In the last two decades, multiple endoscopic alternatives managements to TURP have developed with the main goal to decrease perioperative morbidity. Since the seminal work of Allousi describing an ejaculation-preserving (ep)-TURP technique [5], other alternatives to conventional TURP including laser adenomectomy, ablation, and prostatic urethral lift (PUL) procedures and prostatic arterial embolization (PAE) aimed to preserve sexual function and antegrade ejaculation (AE) while effective and safely desobstructing [2, 6]. Most of them have been tested in terms of ejaculatory outcomes against the conventional TURP or sham either in observational or RCTs [2, 6].
These efforts may reflect the concern of the Urological community to maintain or improve the health-related quality of life (HRQoL) of the patients in need of surgery or the increasing reluctance of patients and partners to conform with the loss of an important component of their sexual life. Considering the consistent association of LUTS and BPO with erectile dysfunction (EF) and ejaculatory dysfunction (EjD) [6, 7], the sexual life of a proportion of those candidates to surgical relief of obstruction and their partners tends to be fragile and already influencing HRQoL before any kind of surgical or ablative management [7]. Moreover, it is increasingly recognized that RE is one, although not the only of the various conditions that conform to the spectrum of the EjD present in the older men [8].
The goals of the present narrative review are to describe the rates of EjD and RE after endoscopic surgery and minimally invasive procedures for BPO and the impact of “de novo onset” of both symptoms in male patients and on the couple’s sexual ambiance.
Results
*Rates of ejaculatory dysfunction or retrograde ejaculation
*Adenomectomy techniques
*Vaporization techniques
*New minimally invasive techniques
*Ejaculation‑preserving techniques
Patient’s and partner’s perception and values regarding ejaculatory dysfunction or retrograde ejaculation
*Aging male and sexual function
*Male LUTS and sexual function
*Male sexual function and partner satisfaction
In conclusion, a considerable degree of EjDs is already present in men with moderate or severe LUTS candidates for endoscopic surgery. Overall, EjDs may cause patient and partner distress and sexual dissatisfaction. Preservation of AE is feasible and available data suggest that the rate of EjD or RE after conventional TURP/laser treatment is significantly higher than after different endoscopic ejaculation preserving modifications or minimally invasive treatments of BPO. The psychological effects and the impact of “de novo” EjDs/RE on the QoL and sexual life of the couple are badly and insufficiently described. Focus on appropriate measurement of changes from pre to post-surgery and on dyadic instead of individual assessment will definitely address the question of to whom it is worth to offer an ejaculation-preserving technique.
Purpose To review the current data on retrograde ejaculation (RE) and ejaculatory dysfunction (EjD) after endoscopic and minimally invasive surgical treatment of benign prostatic obstruction (BPO) and, their perceived impact on the quality of life (QoL) and sexual life of patients and their partners.
Methods Narrative review of systematic reviews (SR) assessing comparative rates of RE, EjD, or erectile dysfunction (EF) was carried out. Relevant articles on the prevalence of RE, EjD, or EF and on their impact on the QoL or sexual life of patients and partners were manually selected based on relevance.
Results Twelve SRs reporting on comparisons of different endoscopic/minimally invasive treatments of BPO were found. Data on outcomes varied widely. Overall, after conventional TURP or laser techniques 42–75% of patients present RE. Prostatic incision and ablative procedures present the lowest rates of de novo RE or EjD whereas laser adenomectomy and ejaculation preservation procedures preserve antegrade ejaculation in 46–68% of patients. EjDs are associated with LUTS and present in 10% of sexually active men before intervention. It modulates the QoL and sexual life of the couple. In spite of the scarce literature assessing patient’s and partner’s perceptions of postoperative EjD, it strongly suggests that both parties value the maintenance of the ejaculatory function.
Conclusion Ejaculation-preserving techniques and minimally invasive techniques successfully prevent BPO treatment-induced RE or EjD in 70–100% of the cases. While this is appealing to patients and spouses, technique selection and treatment durability are issues to be discussed with the couple.
Introduction
It is estimated that around half of men suffering severe or medical treatment unresponsive lower urinary tract symptoms (LUTS) will be offered a surgical procedure to relieve benign prostatic obstruction (BPO) [1]. When surgery is indicated, transurethral resection and incision of the prostate (TURP, TUIP) remain the cornerstone for glands>30 mL and < 30 mL, respectively [2]. Whilst efficacy of the conventional TURP is proven, a common potentially bothersome side effects, retrograde ejaculation (RE) occurs in 65.4–86% of the sexually active patients [3, 4].
In the last two decades, multiple endoscopic alternatives managements to TURP have developed with the main goal to decrease perioperative morbidity. Since the seminal work of Allousi describing an ejaculation-preserving (ep)-TURP technique [5], other alternatives to conventional TURP including laser adenomectomy, ablation, and prostatic urethral lift (PUL) procedures and prostatic arterial embolization (PAE) aimed to preserve sexual function and antegrade ejaculation (AE) while effective and safely desobstructing [2, 6]. Most of them have been tested in terms of ejaculatory outcomes against the conventional TURP or sham either in observational or RCTs [2, 6].
These efforts may reflect the concern of the Urological community to maintain or improve the health-related quality of life (HRQoL) of the patients in need of surgery or the increasing reluctance of patients and partners to conform with the loss of an important component of their sexual life. Considering the consistent association of LUTS and BPO with erectile dysfunction (EF) and ejaculatory dysfunction (EjD) [6, 7], the sexual life of a proportion of those candidates to surgical relief of obstruction and their partners tends to be fragile and already influencing HRQoL before any kind of surgical or ablative management [7]. Moreover, it is increasingly recognized that RE is one, although not the only of the various conditions that conform to the spectrum of the EjD present in the older men [8].
The goals of the present narrative review are to describe the rates of EjD and RE after endoscopic surgery and minimally invasive procedures for BPO and the impact of “de novo onset” of both symptoms in male patients and on the couple’s sexual ambiance.
Results
*Rates of ejaculatory dysfunction or retrograde ejaculation
*Adenomectomy techniques
*Vaporization techniques
*New minimally invasive techniques
*Ejaculation‑preserving techniques
Patient’s and partner’s perception and values regarding ejaculatory dysfunction or retrograde ejaculation
*Aging male and sexual function
*Male LUTS and sexual function
*Male sexual function and partner satisfaction
In conclusion, a considerable degree of EjDs is already present in men with moderate or severe LUTS candidates for endoscopic surgery. Overall, EjDs may cause patient and partner distress and sexual dissatisfaction. Preservation of AE is feasible and available data suggest that the rate of EjD or RE after conventional TURP/laser treatment is significantly higher than after different endoscopic ejaculation preserving modifications or minimally invasive treatments of BPO. The psychological effects and the impact of “de novo” EjDs/RE on the QoL and sexual life of the couple are badly and insufficiently described. Focus on appropriate measurement of changes from pre to post-surgery and on dyadic instead of individual assessment will definitely address the question of to whom it is worth to offer an ejaculation-preserving technique.
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