Impact on Sexual Function of Holmium Laser Enucleation Versus Transurethral Resection of the Prostate: Results of a Prospective, 2-Center, Randomized Trial

Purpose

We compared the impact of HoLEP and TURP on sexual function.

Materials and Methods

Between January 2002 and January 2003, 120 patients with a mean age ± SD of 65.2 ± 7.1 years who had benign prostatic hyperplasia were enrolled in this 2-center, prospective, randomized study. A total of 60 patients with a mean age of 65.25 ± 6.9 years underwent HoLEP (group 1) and 60 with a mean age of 64.18 ± 7.2 years underwent TURP (group 2). Patients were assessed before surgery, and at 12 and 24-month followup visits. Subjective symptoms were scored by the International Prostate Symptom Score, the International Prostate Symptom Score quality of life question, IIEF, 10 nonvalidated general assessment questions, physical examination, serum prostate specific antigen and transrectal ultrasonography.

Results

A total of 32 patients (53.3%) in group 1 and 31 (51.6%) in group 2 reported various degrees of erectile dysfunction before surgery according to the IIEF-EF score. Differences between preoperative and postoperative orgasmic domain scores in each group were significant (p <0.001). A slight but not significant increase in the mean IIEF-EF domain score was reported in each group at postoperative assessments without any difference between the 2 surgical approaches. According to general assessment question analysis the prevalence of subjectively reported postoperative retrograde ejaculation was significantly higher than at baseline assessment in the 2 groups with no differences between the 2 surgical procedures.

Conclusions

TURP and HoLEP significantly lowered the IIEF orgasmic function domain with no differences between techniques. This was caused by retrograde ejaculation. Marginal, nonsignificant erectile function improvement was reported after surgery in the 2 groups.

Key Words:  penis , impotence , lasers , prostate , prostatic hyperplasia

Abbreviations and Acronyms:  BPH, benign prostatic hyperplasia , ED, erectile dysfunction , EF, erectile function , GAQ, general assessment question , HoLEP, holmium laser enucleation of the prostate , IIEF, International Index of EF , I-PSS, International Prostate Symptom Score , LUTS, lower urinary tract symptoms , QOL, quality of life , TURP, transurethral resection of the prostate