PD45-07: Prospective comparison of functional outcomes after endoscopic surgical interventions for Benign Prostatic Hyperplasia: the role of Ejaculation-Sparing anatomic Photoselective Vaporization of the Prostate (ESa-PVP)

Mattia Sibona*, Paolo Destefanis, Federico Vitiello, Eugenia Vercelli, Gabriele Montefusco, Alessandro Mara, Andrea Bosio, Alessandro Bisconti, Paolo Gontero, Turin, Italy

Introduction: Ejaculatory Dysfunction (EjD) is still a common event after Benign Prostatic Hyperplasia (BPH) surgery, causing significant bother to younger and sexually active patients (pts). Recently, several ejaculation-sparing techniques were described. Ejaculation-sparing anatomic Photoselective Vaporization of the Prostate (ESa-PVP) with LBO laser has been proposed as a sexual function-sparing evolution of the anatomic PVP technique, showing promising preliminary results. The aim of our study was to present a prospective comparison of functional outcomes from a cohort of ESa-PVP pts versus standard PVP and Transurethral Resection of the Prostate (TUR-P).

Methods: Local Ethics Committee approval was obtained (n. 643/2018). Our study was conceived as a prospective, observational analysis. From 03/2018 to 06/2020, we enrolled pts undergoing endoscopic surgery for BPH at our institution (Molinette Hospital, Turin). Inclusion criteria: age > 50, sexually active, moderate to severe Lower Urinary Tract Symptoms (LUTS) [IPSS > 8]. Urinary and sexual function data were collected at baseline and at 6 and 12 month after surgery. Validated questionnaires were used to assess functional results (IPSS, IIEF5, MSHQ-Ej). Included pts were divided into groups, according to the type of intervention: bipolar TUR-P (group A); standard PVP (group B); ESa-PVP (group C).

Results: Globally, 95 pts were included (46 in group A, 26 in group B, 23 in group C). Median (IQR) age was 66 (60-71) years. Median prostate volume was 63 (50-90) cc. Median baseline IPSS score within groups was 25 vs 24.5 vs 28 (p=0.442); median IIEF-5 score was 21 vs 23.5 vs 20 (p=0.339); median MSHQ-Ej score was 30 vs 33.5 vs 34 (p=0.137). Baseline antegrade ejaculation rate was 84.78% vs 80.77% vs 91.30% (p=0.579). At 6-month follow-up, urinary and sexual function scores changed as follows: median IPSS: 6 vs 5 vs 1 (p=0.019); median IIEF5: 21 vs 21.5 vs 19 (p=0.750); median MSHQ-Ej: 4 vs 2 vs 15 (p=0.001). 6-month antegrade ejaculation rate was 28.89% vs 23.08% vs 60.87% (p=0.010). 12 months after surgery, no significant differences in IPSS and IIEF5 scores were detected within groups. Instead, median MSHQ-Ej score was 2 vs 2 vs 25 (p=0.006) and antegrade ejaculation rate was 26.09% vs 13.04% vs 58.82% (p=0.007). At a multivariable logistic regression analysis, pre-operative MSHQ-Ej score was identified as an independent predictor of antegrade ejaculation preservation both at 6 and 12 months, while surgical technique appeared as a significant predictor of the same outcome at 6 months.

Conclusions: The Ejaculation-Sparing anatomic PVP technique (ESa-PVP) showed superiority over standard PVP and TUR-P in preserving antegrade ejaculation both at 6 and 12 month follow-up after BPH surgery.

Source of Funding: none