Ejaculatory disorders after surgical treatment of benign prostatic hyperplasia

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Abstract

Introduction. Ejaculation disorders occur in 62-75% of patients after surgical treatment for benign prostatic hyperplasia (BPH). Despite the development and widespread introduction into clinical practice of laser procedures, which have reduced the overall incidence of complications, the frequency of ejaculatory disorders is still high. This complication negatively affects the quality of life of patients.

Aim. To study the nature of ejaculation disorders in patients with BPH after surgical treatment. In this work, we did not compare the effect of various surgical methods and techniques in patients with BPH on ejaculation. At the same time, we selected the most widely used procedures in routine urological practice and assessed the presence and development of ejaculatory dysfunction prior to and after surgery. It should be emphasized that we determined the disorders that occurred in the same patients in whom ejaculatory function was evaluated prior to surgery.

Materials and methods. A prospective study of the ejaculatory function of 224 sexually active men aged 49 to 84 years with LUTS/BPH before and after surgical treatment was performed. From 2018 to 2021, thulium laser enucleation of prostatic hyperplasia (ThuLep) was done in 72 patients, conventional TURP in 136 patients, and 16 patients underwent open transvesical simple prostatectomy. Surgical treatment was carried out by certified urologists with extensive experience. ThuLep and conventional TURP were not ejaculatory-sparing. All patients underwent a standard examination for LUTS/BPH pre- and postoperatively, including IPSS score, uroflowmetry to determine the maximum urine flow rate (Qmax), PSA, urinalysis, transrectal ultrasound examination with a calculation of prostate volume, postvoid residual. The erectile function was assessed according to the IIEF-5 score. Ejaculation function was evaluated according to the Male Sexual Health Questionnaire (MSHQ-EjD) preoperatively and at 3- and 6-months follow-up. For the diagnosis of premature ejaculation, CriPS questionnaire was used. For the differential diagnosis of retrograde ejaculation and anejaculation after surgical treatment, patients underwent an analysis of post-orgasmic urine for the presence and quantity of spermatozoa.

Results. The average age of patients was 64 years. At baseline, various ejaculatory disorders were detected in 61.6% of cases. In 48.2% of patients (n=108) a decrease in the ejaculate volume was found, while 47.3% (n=106) noted a decrease in the intensity of ejaculation. In 15.2% of cases (n=34), acquired premature ejaculation was detected, and 17% (n=38) men reported pain or discomfort during ejaculation. In addition, 11.6% (n=26) had delayed ejaculation during intercourse. There were no patients with anejaculation at baseline. The average score on the IIEF-5 scale was 17.9, and on the IPSS scale 21.5 points.

Three months after surgical treatment, the following disorders of ejaculation were documented: retrograde ejaculation in 78 (34.8%), anejaculation in 90 (40.2%) patients. In the remaining 56 (25%) men, antegrade ejaculation was preserved. Among those with antegrade ejaculation, an additional survey was carried out, which showed a decrease in ejaculate volume and in the intensity of ejaculation in 46 (20.5%) and 36 (16.1%) cases, respectively. Pain during ejaculation was noted by 4 (1.8%) men, however, there was neither premature nor delayed ejaculation after surgical treatment.

Conclusion. In patients with BPH, the predominate types of ejaculation disorders before surgical treatment were as following: a decrease in ejaculate volume (48.2%), a decrease in the speed (intensity) of ejaculation (47.3%), painful ejaculation (17%), premature ejaculation (15.2%), and delayed ejaculation (11.6%). After surgical treatment, retrograde ejaculation (34.8%, n=78) and anejaculation (40.2%, n=90) prevailed.

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About the authors

M. N. Rustamov

Institute of Urology and Human Reproductive Health, FGAOU VO I.M. Sechenov First Moscow State Medical University; NUZ KB “RJD-Medicine”

Author for correspondence.
Email: rustamovmaarif@gmail.com
ORCID iD: 0000-0003-4768-3841

correspondence Ph.D. student

Russian Federation, Moscow; Kazan

O. F. Galiullin

NUZ KB “RJD-Medicine”

Email: rustamovmaarif@gmail.com

cardiovascular surgeon, Chief

Russian Federation, Kazan

A. Z. Vinarov

Institute of Urology and Human Reproductive Health, FGAOU VO I.M. Sechenov First Moscow State Medical University

Email: avinarov@mail.ru

Ph.D., MD, professor

Russian Federation, Moscow

References

  1. Oelke M., Bachmann A., Descazeaud A., et al. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol. 2013;64:118–40.
  2. Mebust W.K. et al. 1989; Briganti A. et al. 2006; Meng F. 2007 et al. Donovan J.L. et al. 2010; Marra G. et al. 2016.
  3. Rosen R.C., Riley A., Wagner G. et al. The international index of erectile function (IIEF): A multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49:822–830.
  4. Briganti A., Naspro R., Gallina A., Salonia A., Vavassori I., Hurle R., Montorsi F. Impact on Sexual Function of Holmium Laser Enucleation Versus Transurethral Resection of the Prostate: Results of a Prospective, 2-Center, Randomized Trial. J Urol. 2006;175(5):1817–1821. doi: 10.1016/s0022-5347(05)00983-3.
  5. Yee C.L., Pal R.P., Batchelder A., Khan M.A. Risk of erectile dysfunction and retrograde ejaculation associated with thulium laser vaporesection of the prostate for bladder outflow obstruction: a retrospective study. Urol Int. 2012; 88(2):165–69. doi: 10.1159/000333046.
  6. Saredi G., Pacchetti A., Pirola G.M., Martorana E., Berti L., Scroppo F.I., Marconi A.M. Impact of Thulium Laser Enucleation of the Prostate on Erectile, Ejaculatory and Urinary Functions. Urol Int. 2016;97(4):397–401. doi: 10.1159/000446829. Epub 2016 Jul 28. PMID: 27463971.
  7. Carmignani L, Bozzini G, Macchi A, et al. Sexual outcome of patients undergoing thulium laser enucleation of the prostate for benign prostatic hyperplasia. Asian J Androl. 2015;17:802–806
  8. Sturch P., Woo H.H., McNicholas T., Muir G. Ejaculatory dysfunction after treatment for lower urinary tract symptoms: retrograde ejaculation or retrograde thinking? BJU Int. 2015;115(2):186–187. doi: 10.1111/bju.12868.
  9. Bell J.R., Laborde E. Update on the sexual impact of treatment for benign prostatic hyperplasia. Curr. Urol. Rep. 2012; 13: 433–440.
  10. Marra G., Sturch P., Oderda M. и др. Systematic review of lower urinary tract symptoms/benign prostatic hyperplasia surgical treatments on men’s ejaculatory function: Time for a bespoke approach? International Journal of Urology. 2016;23(1):22–35.
  11. Gacci M., Bartoletti R., Figlioli S., Sarti E., Eisner B., Boddi V., Rizzo M. Urinary symptoms, quality of life and sexual function in patients with benign prostatic hypertrophy before and after prostatectomy: A prospective study. BJU Int. 2003;91:196–200.
  12. Briganti A., Naspro R., Gallina A., Salonia A., Vavassori I., Hurle R., Montorsi, F. Impact on Sexual Function of Holmium Laser Enucleation Versus Transurethral Resection of the Prostate: Results of a Prospective, 2-Center, Randomized Trial. J Urol. 2006;175(5):1817–1821. doi: 10.1016/s0022-5347(05)00983-3.
  13. El-Assmy A., ElShal A.M., Mekkawy R., El-Kappany H., Ibrahiem E.H.I. Erectile and ejaculatory functions changes following bipolar versus monopolar transurethral resection of the prostate: a prospective randomized study. Int Urol Nephrol. 2018;50(9):1569–1576. doi: 10.1007/s11255-018-1950-6. Epub 2018 Aug 6. PMID: 30083842.
  14. Chen Q., Zhang L., Fan Q.L., Zhou J, Peng Y.B., Wang Z. Bipolar transurethral resection in saline vs traditional monopolar resection of the prostate: results of a randomized trial with a 2-year follow-up. BJU Int. 2010;106:1339–1343.
  15. Tefekli A., Muslumanoglu A.Y., Baykal M., Binbay M., Tas A., Altunrende F. A hybrid technique using bipolar energy in transurethral prostate surgery: a prospective, randomized comparison. J. Urol. 2005;174:1339–1343.
  16. Frieben R.W., Lin H.C., Hinh P.P., Berardinelli F., Canfield S.E., Wang R. The impact of minimally invasive surgeries for the treatment of symptomatic benign prostatic hyperplasia on male sexual function: a systematic review. Asian J Androl. 2010;12(4):500–08. doi: 10.1038/aja.2010.33.
  17. Lokeshwar S.D., Valancy D., Lima T.F.N. et al. A Systematic Review of Reported Ejaculatory Dysfunction in Clinical Trials Evaluating Minimally Invasive Treatment Modalities for BPH. Current Urology Reports. 2020;21:12.
  18. McVary K.T., Rogers T., Mahon J., Gupta N.K. Is sexual function better preserved after water vapor thermal therapy or medical therapy for lower urinary tract symptoms due to benign prostatic hyperplasia? J Sex Med. 2018;15(12):1728–1738.
  19. McVary K.T., Gange S.N.., Gittelman MC., et al. Erectile and ejaculatory function preserved with convective water vapor energy treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: randomized controlled study. J Sex Med. 2016;13(6): 924–933.
  20. Dixon C., Cedano E.R., Pacik D., Vit V., Varga G., Wagrell L., et al. Efficacy and safety of Rezūm system water vapor treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia. Urology. 2015;86(5):1042–1047.
  21. Plante M., Gilling P., Barber N., Bidair M., Anderson P., Sutton M., Aho T., Kramolowsky E., Thomas A., Cowan B., Kaufman R.P. Jr, Trainer A., Arther A., Badlani G., Desai M., Doumanian L., Te A.E., DeGuenther M., Roehrborn C. Symptom relief and anejaculation after aquablation or transurethral resection of the prostate: subgroup analysis from a blinded randomized trial. BJU Int. 2019;123(4):651–660. doi: 10.1111/bju.14426.
  22. Gilling P., Barber N., Bidair M. et al. WATER – a doubleblind randomized controlled trial of Aquablation vs. transurethral resection of the prostate in benign prostatic hyperplasia. J Urol. 2018. https ://doi.org/10.1016/j.juro.2017.12.065
  23. Roehrborn C.G., Barkin J., Gange S.N., et al. Five year results of the prospective randomized controlled prostatic urethral L.I.F.T. study. Can J Urol. 2017;24(3):8802–8813.
  24. Shim S.R., Kanhai K.J., Ko Y.M., Kim J.H. Efficacy and safety of prostatic arterial embolization: systematic review with metaanalysis and meta-regression. J Urol. 2017;197(2):465–479. https ://doi. org/10.1016/j.juro.2016.08.100
  25. Ray A.F., Powell J., Speakman M.J., Longford N.T., DasGupta R., Bryant T., Modi S., Dyer J., Harris M., Carolan-Rees G., Hacking N. Efficacy and safety of prostate artery embolization for benign prostatic hyperplasia: an observational study and propensity-matched comparison with transurethral resection of the prostate (the UK-ROPE study). BJU Int. 2018;122(2):270–282. https ://doi. org/10.1111/bju.14249
  26. Martov A.G., Andronov A.S., Dutov S.V., Baykov N.A. Ejaculatory-protective transurethral resection of the prostate. Urologiia. 2014;4:69–75. Russian (Мартов А.Г., Андронов А.С., Дутов С.В., Байков Н.А. Эякуляторно-протективная трансуретральная резекция предстательной железы. Урология. 2014; 4:69–75).

Supplementary files

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2. Fig. 1. The structure of sexual disorders in patients with CHM/GPJ before surgical treatment

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3. Fig. 2. Ejaculation disorders 3 months after surgical treatment (n=224)

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4. Fig. 3. Ejaculation disorders 6 months after surgical treatment (n=224)

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