MP04-10: Risk of orgasmic function impairment after HoLEP – findings of a prospective real-life trial (ExpHo)

Paolo Capogrosso*, Varese, Italy, Eugenio Ventimiglia, Giuseppe Fallara, Antonio Costa, Francesco Pellegrino, Luigi Candela, Edoardo Pozzi, Federico Belladelli, Mario De Angelis, Gianmarco Colandrea, Walter Cazzaniga, Daniele Cignoli, Nicolò Schifano, Rayan Matloob, Milan, Italy, Federico Dehò, Varese, Italy, Vincenzo Scattoni, Andrea Salonia, Francesco Montorsi, Milan, Italy

Introduction: Laser enucleation of the prostate is associated with an invariable risk of retrograde ejaculation which may affect patient’ sexual life with a negative impact toward orgasmic function (OF). We investigated OF outcomes after Holmium Laser Enucleation of the Prostate (HoLEP) in patients consecutively treated at a single center.

Methods: The ExpHo trial (NCT03583034) is a prospective observational study collecting data of patients submitted to HoLEP at a single center. Surgeries were performed by a single highly experienced surgeon. Before surgery, all patients completed the International Index of Erectile Function (IIEF) thus including the OF domain. Non-sexually active patients were excluded. Patients were re-assessed at 1 week, 1-, 3-, 6- and 12-mos. Kaplan-Meier analyses estimated OF recovery over time (defined as: IIEF-OF score>= than baseline). Logistic regression model tested baseline characteristics associated with the risk of postoperative OF worsening.

Results: Data were available for 135 patients. Median (IQR) age was 66 (62,73) years. Median prostate volume (PV) 81 cc (63,110). Overall, 46 (64%) patients had IIEF scores suggestive for ED before surgery. Median IIEF-OF score at baseline was 6 (0,10). Overall, 34% (46) reported a decreased OF after surgery. Mean IIEF-OF score significantly decreased at 1-mo follow-up compared to baseline (6.1 vs. 3.; p<0.0001), with a subsequent improvement at 3-mo (IIEF-OF: 5.4) and 6-mo (IIEF-EF: 5.9), respectively. The estimated (95%CI) postoperative OF recovery rates were 44% (35,54), 62% (53,72), and 77% (66,86) at 1-,3- and 12-mos follow-up. Younger patients (OR: 0.91, 95%CI:0.8-0.9; p=0.03) and patients with normal preoperative IIEF-EF (OR:3.4,95%CI1.1,11.5; p=0.04) emerged to have higher risk of reporting a postoperative decreased IIEF-OF (Figure 1).

Conclusions: One out three patients reported a decrease in OF after HoLEP. Younger patients with normal baseline EF should be carefully counselled regarding the risk of retrograde ejaculation associated with laser enucleation of the prostate.

Source of Funding: None