Results of ejaculatory-protective laser enucleation of the prostate

Introduction. Benign prostatic hyperplasia (BPH) is a condition that occurs in up to 1/3 of men over 50 years of age and can lead to lower urinary tract symptoms (LUTS) requiring surgical treatment. The main adverse event that men experience after surgical methods of alleviating LUTS is the ejaculatory dysfunction. Currently, surgical techniques are available that increase the chance of maintaining antegrade ejaculation after endoscopic treatment of BPH.

Aim. To evaluate the efficiency and safety of ejaculatory-protective laser enucleation of the prostate with respect to preservation of antegrade ejaculation and improvement of urinary parameters.

Materials and methods. From December 2020 to January 2023, 75 ejaculatory-protective laser enucleations of the prostate were performed in City Clinical Hospital No. 1 named after N.I. Pirogov, Moscow (study group). In addition, 61 patients underwent the classical laser enucleation technique (control group). The study included sexually active men with antegrade ejaculation, who were re-examined 18 months after surgical treatment. Comprehensive history data were collected using the questionnaires, such as IPSS (International Prostate Symptom Score) and IIEF-5 (International Index of Erectile Function). Moreover, ejaculatory function was assessed, and each patient underwent a wide range of clinical, laboratory and instrumental studies, including transrectal ultrasound of the prostate and bladder ultrasound with determination of the postvoid residual volume and uroflowmetry.

Results. In both groups, significant changes in IPSS, quality of life (QoL) were found, while there were no significant differences in IIEF-5 scores in patients who underwent the ejaculatory-protective technique, and, on the contrary, in those undergoing classical laser enucleation, a significant decrease in the total IIEF-5 score from 18.9±3.3 to 17.6±4.0 (p<0.05) was noted. According to the survey, 36 patients (48%) reported a preservation of antegrade ejaculation after the ejaculatory-protective laser enucleation. The chances in patients who underwent the ejaculatory-protective technique were 2.372 times higher than in the classical enucleation; the difference was significant (OR=0.361; 95% CI: 0.169–0.769). Roc analysis revealed that the highest chance of a preservation of antegrade ejaculation was observed with a prostate volume of 66.3 cc or less. A decrease in the total IIEF-5 score with a simultaneous increase in the frequency of ejaculatory dysfunction in patients who underwent the classical laser enucleation of the prostate may indicate a decrease in the perceived quality of sexual life after the loss of antegrade ejaculation. According to the instrumental studies in both groups, the maximum urine flow rate and postvoid residual volume 18 months after surgical treatment were significantly different (p<0.05) from the baseline parameters, indicating an improvement in the quality of urination regardless of the chosen technique.

Conclusion. Ejaculatory-protective laser enucleation of the prostate is a safe and effective alternative to standard technique of laser enucleation of the prostate.