To report ejaculatory and urinary results in patients who underwent holmium laser enucleation of the prostate (HoLEP) with selective laser enucleation of the median lobe (MLHoLEP).
Patients with lower urinary tract symptoms (LUTS)/benign prostatic obstruction (BPO) who underwent MLHoLEP to preserve ejaculatory function in a single center were retrospectively identified. Urinary function was assessed using International Prostate Score Symptom (IPSS), IPSS-Quality of Life index (IPSS-QoL), peak urinary flow (Qmax) and postvoid residual (PVR). Erectile function was assessed using International Index of Erectile Function (IIEF-5). In patients with preoperative antegrade ejaculation, retrograde ejaculation was routinely screened at each follow-up visit. Sexual and urinary functions at 3 and 12 months were compared with baseline values.
A total of 55 patients met our inclusion criteria. A significant improvement in the IPSS, IPSS-QoL, PVR and Qmax was found at 3 and 12 months, compared with baseline (all P<0.05). Eight patients (14.5%) required surgical reintervention due to persistant LUTS/BPO. No significant changes in the erectile function were found at 3 (P=0.3) and 12 months (P>0.9). In patients with preoperative antegrade ejaculation (n=32), only four cases of de novo retrograde ejaculation were recorded postoperatively.
MLHoLEP represents a new alternative for men with LUTS/BPO who wish to preserve their ejaculatory function. Patients should be aware that improvement in urinary function may be inferior to the traditional technique, with a higher reintervention rate due to persistent LUTS.
Grade 4.
The French journal of urology. 2024 Feb 03 [Epub]
Thibaut Long Depaquit, Michael Baboudjian, Paul Chiron, Renaud Corral, Vassili Anastay, Cyrille Bastide, Harry Toledano
Department of Urology, HIA Sainte-Anne, Toulon, France; Department of Urology, North Hospital, AP-HM, Marseille, France. Electronic address: ., Department of Urology, North Hospital, AP-HM, Marseille, France., Department of Urology, HIA Begin, Saint-Mandé, France., Department of Urology, North Hospital, AP-HM, Marseille, France; Department of Urology, Martigues Hospital, Martigues, France.