Introduction: Holmium laser enucleation enucleation of the prostate (HoLEP) has been associated with a low risk of erectile dysfunction (ED). We investigated factors associated with risk of erectile function (EF) worsening after surgery for men with normal pre-operative EF. Methods: The ExpHo trial (NCT03583034) is a prospective study collecting data of consecutive patients treated with HoLEP by one highly-experienced surgeon (>1500 cases), at a single centre. All patients completed the International Index of Erectile Function (IIEF) at baseline and those with normal IIEF-EF (>26) were considered for this analysis. Patients have been re-assessed at 1 week, and at 1, 3, 6 and 12 months throughout the follow-up (FU). Kaplan Meier analysis investigated the risk of EF decrease over time. Cox-regression model tested predictors of post-operative EF worsening. Results: Of 242 patients, 66 reported normal IIEF-EF before surgery. Baseline median (IQR) age was 65(60-70) years and prostate volume (PV) was 75(58-100) mL. Median pre-operative IIEF-orgasmic function (OF) was 10(7-10). Median follow-up was 6(1-12) months. At Kaplan-Meier analysis, estimated rates of EF impairment depicted an increase over time, with 12%(95%CI: 6,25) and 19%(95%CI: 11,33) of patients with normal pre-operative EF reporting a post-operative worsening at 3 and 6 months, respectively. Median IIEF-EF score decrease was 4 (2-11). At cox regression analysis, baseline factors (i.e., age, BMI, Charlson Comorbidiy Index, PV, IPSS) and intraoperative factors (i.e., total energy used, capsule perforation) were not associated with EF decrease over time (all p>0.6). Conversely, patients experiencing a post-operative decrease of IIEF-OF were at higher risk of reporting IIEF-EF worsening (IIEF-OF: HR 0.81; 95%CI: 0.59, 0.94; p=0.009) (Figure 1) Conclusions: Sexually active patients with normal pre-operative sexual function may experience a non-negligible EF worsening after HoLEP, which appears associated with post-operative OF decrease, thus suggesting that the impairment of antegrade ejaculation could play a major influence in post-HoLEP sexual function. SOURCE OF Funding: None
