Category: BPH/LUTS: Electrosurgery, Lasers & Other Technology

MP11-21 - Thulium Fiber Laser Enucleation of the Prostate: Could it Improve Erectile Function in Patients with BPH?

Fri, Sep 21
2:00 PM - 4:00 PM

Introduction & Objective :

Benign prostatic hyperplasia (BPH) itself and most of the surgical interventions in patients with lower urinary tract symptoms caused by BPH may affect erectile function (EF). However, thulium fiber laser enucleation (ThuFLEP), due to it shallow penetration (0.2 mm), only has a minor influence on tissue.


The aim: to evaluate sexual and erectile function in patients with benign prostatic hyperplasia who underwent ThuFLEP.


Methods :

We retrospectively assessed pre- and postoperative parameters of 218 male patients aged 54 to 86 years. We included patients with poor urination (IPSS>20 or Qmax<10). Functional parameters (IPSS, QoL, Qmax, PVR) and IIEF (erectile function, orgasmic function, sexual desire and general satisfaction with sexual intercourse) were evaluated before treatment and 6 months after. 


Results : It is important to note that most parameters remained almost unchanged, although the orgasmic function score decreased due to retrograde ejaculation in 166 patients (76.1%). Patients reported better mean overall satisfaction (7.4-8.1) that correlated with an improvement in the QoL (3.9-1.0) and IPSS (22.1-11.5) scores. It is also noteworthy that this insignificant increase was mainly determined by stronger sexual desire (5.9-8.0) and intercourse satisfaction domains (10.3-11.2). The number of patients with complaints of erectile disorders was not increased. Importantly, the effect of this surgical intervention was more pronounced in the group of patients with inherently more severe erectile dysfunction than in the groups with pre-existing less severe dysfunction. 


Conclusions : ThuFLEP results in a significant improvement in the parameters related to urological symptoms (IPSS), QoL and does not influence the values pertaining to erectile function. Despite the occurrence of postoperative retrograde ejaculation in a large percentage of patients, most of them did not regard this complication as significant which was evidenced by higher postoperative QoL and IIEF scores compared with preoperative findings. These facts allow us to consider ThuFLEP a technique that may preserve and, in certain cases, improve erectile function in patients with BPH. 

Ekaterina Laukhtina

Student
Sechenov University
Moscow, Moskva, Russia

Dmitry Enikeev

Deputy Director for Science
Institute for Urology and Reproductive health, Sechenov University
Moscow, Moskva, Russia

Surgical experience:
Experienced in TURP (>300 surgeries).
Experienced in upper urinary tract endosurgery (PCNL >200, RIRS >200).

2008-Present: Multiple upper and lower urinary tract surgeries;
2011-Present: HoLEP (400 surgeries);
2011-Present: En-bloc enucleation of bladder tumor (50 surgeries);
2016-Present: ThuLEP (>400 surgeries);
2016-Present: Thulium en-bloc enucleation of bladder tumor (>80 surgeries);
2016-Present: Brachytherapy (>40 surgeries); prostate cryoablation (70 surgeries), renal cancer cryoablation (30 surgeries);
Apr 2017-Present: Irreversible electroporation (10 surgeries);
Apr 2017-Present: MR-fusion prostate biopsy (80 procedures).

Petr Glybochko

Director
RI for Uronephrology, Sechenov University
Moscow, Moskva, Russia

Leonid Rapoport

Deputy Director
RI for Uronephrology, Sechenov University
Moscow, Moskva, Russia

Nika Akhvlediani

Professor
Department of Urology Sechenov University
Moscow, Moskva, Russia

Mark Taratkin

Researcher
Institute for Urology, Sechenov University
Moscow, Moskva, Russia

Researcher at the Institute for Urology and Reproductive health, Sechenov University.
Head of the laser technology lab.