Male Sexual Function Outcome After Three Laser Prostate Surgical Techniques: A Single Center Perspective - 30/10/12
Reprint requests: Mostafa Elhilali, O.C., O.Q., M.D., Ph.D., F.R.C.S.C., Stephen Jarislowsky Chair of Urology, McGill University, Royal Victoria Hospital, 687 Pine Ave. West, Room S6.95, Montreal, Quebec H3A 1A1 CanadaRésumé |
Objective |
To assess the change and predictors of sexual-related outcomes after laser prostate surgery.
Methods |
This is a longitudinal study of 216 sexually active men who underwent laser prostatectomy between 2005 and 2010. The International Index of Erectile Function-15 questionnaire was used both preoperatively and during the first year of follow-up. Cases with unreliable answers or patients without interested partners were excluded. All relevant data of both groups were depicted and statistically analyzed.
Results |
We identified 191 patients that met the inclusion criteria, 99 holmium laser enucleation of the prostate, 34 holmium laser ablation, and 58 photoselective vaporization of the prostate (GreenLight-532-mm laser photoselective vaporization of the prostate). There were significant differences among the 3 groups regarding the International Index of Erectile Function-15 direction of change at 1 year, being unchanged in (22.2%, 24.4%, and 29.3%), improved in (60.6%, 29.4%, and 41.4), and declined in (17.2%, 41.2%, and 29.3%) in the 3 groups, respectively (P < .05). After adjusting for clinical and perioperative variables, the independent risk factors for decline in the International Index of Erectile Function score were basal International Index of Erectile Function ≥55 and energy to prostate ratio. In holmium laser enucleation of the prostate group, there was significant improvement of the mean overall score, erectile function, desire, and intercourse satisfaction domains (P < .05). In holmium laser ablation and photoselective vaporization of the prostate groups, there were no significant changes between mean preopeative and postoperative scores (P > .05). The incidence of new onset retrograde ejaculation in the holmium laser enucleation of the prostate group was (77.3%) significantly different compared to (31.1%) in the holmium laser ablation group and (33.2%) in photoselective vaporization of the prostate group (P < .05).
Conclusion |
Laser prostate surgery using more size-related laser energy might have possible negative influence on sexual function. Patients with normal preoperative sexuality are more at risk.
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| Financial Disclosure: Mostafa M. Elhilali is a consultant to Lumenis and Laserscope, the other authors have no conflict of interest to declare. |
Vol 80 - N° 5
P. 1098-1104 - novembre 2012 Retour au numéro
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