How can we Preserve Sexual Function after Ablative Surgery for Benign Prostatic Hyperplasia?

Area of Science:

• Urology
• Sexual Medicine
• Surgical Techniques

Background:

• Benign Prostatic Enlargement (BPE) affects many men and can lead to sexual dysfunction.
• Traditional treatments like Transurethral Resection of the Prostate (TURP) are associated with significant sexual side effects, including retrograde ejaculation and erectile dysfunction.
• Ablative surgical techniques have emerged as alternatives aiming to minimize these complications.

Purpose of the Study:

• To review the prevalence, pathophysiology, and management of sexual dysfunction following ablative surgical techniques for BPE.
• To compare the sexual side effect profiles of ablative techniques versus traditional prostate surgery.
• To discuss intraoperative and postoperative management strategies for sexual dysfunction.

Main Methods:

• Narrative review of existing literature on ablative surgical techniques for BPE.
• Analysis of studies reporting on sexual dysfunction (erectile and ejaculatory) post-procedure.
• Evaluation of pathophysiologic pathways and proposed management strategies.

Main Results:

• Ablative techniques, such as Photoselective Vaporization of the Prostate (PVP) and Aquablation®, appear to have a lower incidence of sexual dysfunction compared to TURP.
• Potential for indirect thermal injury to nerves exists with some ablative methods, which could impact erectile function.
• Methodological limitations in current studies, including lack of randomization and sexual function as primary outcomes, hinder definitive conclusions.

Conclusions:

• Ablative surgical techniques for BPE generally show a reduced impact on sexual function compared to TURP.
• Intraoperative surgical technique modifications and established treatments for erectile dysfunction (ED) and ejaculatory dysfunction (EjD) are crucial for managing sexual side effects.
• High-quality research is essential to further elucidate the sexual side effect profiles of BPE surgeries and optimize management strategies.