Introduction: Holmium laser enucleation of the prostate (HoLEP) is the platinum standard surgical procedure for treatment of benign prostatic hyperplasia (BPH). As is common with BPH surgeries, many men develop retrograde ejaculation post-operatively. There is some conflicting evidence regarding the sexual function outcomes of this procedure. We sought to examine sexual outcomes post-HoLEP to assess changes in ejaculatory and erectile function. Methods: With IRB approval, we conducted a retrospective study of patients who underwent HoLEP between Nov 2018 and Feb 2022. 346 patients met inclusion criteria and had completed pre and post operative questionnaires, which included the Male Sexual Health Questionnaire – Ejaculatory Dysfunction (MSHQ- EJD) and the 5 question International Index of Erectile Function/Sexual Health Inventory for Men (IIEF-5/SHIM). Both surveys were provided to patients up to 12 months post procedure. Patient demographics and comorbidities associated with sexual dysfunction were collected. Responses to each question were analyzed to detect sub-categorical improvements or declines in sexual function as the secondary objective. An autoregressive heterogeneous linear mixed model was performed in SPSS 28 to analyze the data. Results: There was a significant decline in the total scores for the MSHQ-EJD from a mean of 7.48 pre-HoLEP to 6.23 post HoLEP (p= 0.001) including a significant decline (p < 0.005) in questions 1-3 which assess ejaculatory ability, strength, and volume; but there was not a significant decline in question 4 which assesses bother in ejaculatory function with a mean of 2.494 pre-HoLEP compared to 2.922 post-HoLEP (p=0.291). There was not a significant decline in the IIEF-5/SHIM post-operatively with mean pre-HoLEP score 9.21 vs 8.87 post-HoLEP (p= 0.98). Conclusions: These findings suggest that patients undergoing HoLEP do not experience a decline in erectile function. Patients do appear to experience a decline in ejaculatory function post-operatively, but do not find the decline to be more bothersome. SOURCE OF Funding: None
