Impact of Thulium Laser Enucleation of the Prostate on Erectile, Ejaculatory and Urinary Functions

Objective: To test the impact of Thulium laser enucleation of the prostate (ThuLEP) on erectile and ejaculatory functions, on lower urinary tract symptoms and on quality of life (QoL). Methods: From July 2013 to May 2015, we prospectively evaluated 177 patients with LUTS related to benign prostatic hyperplasia. All patients were assessed with the International Index of Erectile Function (IIEF-5), Male Sexual Health Questionnaire-Ejaculatory Disease (MSHQ-EjD), International Prostate Symptom Score (IPSS), QoL, PSA and uroflowmetry before and at 4 and 8 months after surgery. Results: Erectile function did not show variation with IIEF-5 preoperative score 22.49 +/- 1.8 and postoperative score 22.14 +/- 3.1 (p = 0.195) and 22.18 +/- 3.2 (p = 0.26) at 4 and 8 months after treatment. The ejaculatory function on the MSHQ-EjD test indicated the reduction of ejaculation, changing from 14.90 +/- 6.88 to 5.51 +/- 4.17 (p < 0.0001) and 5.38 +/- 3.93 (p < 0.0001) at 4 and 8 months follow-up. IPSS score decreased from preoperative 21.12 +/- 5.81 to 3.14 +/- 3.16 (p < 0.0001) and 3.08 +/- 3.12 (p < 0.0001) 4 and 8 months after surgery. PSA decreased from 4.50 +/- 3.72 to 1.39 +/- 1.04 (p < 0.0001) and 1.47 +/- 1.14 ng/ml (p < 0.0001) at 4 and 8 months follow-up, while QoL score improved from 5.41 +/- 0.69 to 0.57 +/- 0.84 (p < 0.0001) and 0.51 +/- 0.80 (p < 0.0001) at 4 and 8 months follow-up. Conclusions: ThuLEP does not affect erectile function and determines the resolution of LUTS with improvement of QoL. Loss of ejaculation did not impair the sexual intercourse activities of the patients. (C) 2016 S. Karger AG, Basel