Prostatic Urethral Lift Versus Medical Therapy: Examining the Impact on Sexual Function in Men with Benign Prostatic...

Area of Science:

• Urology
• Men's Health
• Sexual Medicine

Background:

• Sexual dysfunction is a frequent adverse effect of medical treatments for benign prostatic hyperplasia (BPH).
• Prostatic urethral lift (PUL) offers an alternative for managing lower urinary tract symptoms while preserving sexual function.

Purpose of the Study:

• To conduct a comparative analysis of the long-term effects of PUL versus daily medical therapy (doxazosin, finasteride, or combination) on sexual health in BPH patients.
• To evaluate the impact on erectile function, ejaculatory function, and sexual satisfaction over 48 months.

Main Methods:

• Comparative analysis of sexual function outcomes from PUL trials (L.I.F.T., Crossover, MedLift) and the Medical Therapy of Prostatic Symptoms (MTOPS) trial.
• Inclusion criteria: sexually active men with BPH (I-PSS ≥13, Qmax ≤12ml/s, prostate volume 30-80 cm³).
• Utilized validated questionnaires: Brief Male Sexual Function Inventory (MTOPS), International Index of Erectile Function, and Male Sexual Health Questionnaire for Ejaculatory Function (PUL).

Main Results:

• PUL significantly improved erectile function up to 24 months and ejaculatory function and sexual satisfaction throughout the study period.
• Medical therapy did not show improvement in sexual function; finasteride decreased erectile function at 48 months, and combination therapy reduced ejaculatory function at 12 and 24 months.
• PUL demonstrated superiority over finasteride in preserving erectile function at 24 and 48 months, and over doxazosin and combination therapy at 12 months for sexual satisfaction and ejaculatory function.

Conclusions:

• PUL is superior to traditional medical therapies for BPH in preserving and improving erectile function, ejaculatory function, and sexual satisfaction.
• Patients undergoing PUL experienced improvements in sexual health, whereas those on medical therapy reported worsening sexual function.
• Limitations include the use of different patient-reported outcome measures across studies and limited data on comorbidities.