Selective Laser Enucleation of the Prostate: Preserving Sexual Function without Compromising Urinary Outcomes
Benjamin Press, MD, Eric Ghiraldi, DO, Katelyn Johnson, MD, Hari Nair, Postgraduate Research Associate, Daniel Kellner, MD.
Yale School of Medicine, New Haven, CT, USA.
Selective Laser Enucleation of the Prostate: Preserving Sexual Function without Compromising Urinary Outcomes Eric Ghiraldi, *Ben Press, Katelyn Johnson, Hari Nair, Daniel KellnerBackgroundHolmium laser enucleation of the prostate (HoLEP) is recommended for prostate glands of all sizes and is becoming a popular alternative to the transurethral resection of the prostate (TURP). Side effects of the procedure include stress incontinence, irritative lower urinary tract symptoms, and sexual function, most commonly retrograde ejaculation. Our goal was to evaluate perioperative outcomes related to sexual function and urinary function in patients who underwent selective laser enucleation of the prostate. MethodsRetrospective review of the first 150 cases of HoLEP was performed from May to December 2020. Twelve patients within our cohort underwent selective enucleation of the prostate for an intravesical median lobe or a high bladder neck. Criteria for choosing to treat patients with selective enucleation must have the above criteria without obstructing lateral lobes. 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 (AUA-SS) and asking if they were experiencing urinary incontinence during their follow up appointment. Descriptive statistics and student t-test was used to assess outcomes. Results Mean age of our cohort was 64.2 years of age (Range 52-82 years). One of our patients was in urinary retention requiring an indwelling foley catheter prior to surgery. Average peri-operative AUA-SS scores significantly improved (22.6 vs 3.7, p=0.0003). Average peri-operative quality of life scores significantly improved (4.5 vs 0, p=<0.0001). Average peri-operative post void residual volumes were significantly improved (257.9 vs 60.8, p = 0.04). Of the 12 patients undergoing selective enucleation, 7 patients reported normal ejaculation after the procedure. Two patients were not sexually active prior to their procedure. Data was missing from two patients. One patient had retrograde ejaculation. One patient had to be placed on Myrbetriq post-operatively for persistent irritative voiding symptoms. ConclusionsIn our case series of selective laser enucleation of the prostate urinary function significantly improved peri-operatively with preservation of ejaculation in the majority of our patients. A larger series is necessary with a longer follow up period to further investigate the durability of these findings.
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