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Modified HoLEP technique: does it preserve ejaculation?
Lautaro German Spezzi Roncero1, Guillermo Montelli Yanzi2, Christian Cristallo2
1Department of Urology, Endourology and Benign Prostatic Hyperplasia Sector, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199, Buenos Aires, Argentina. lautarospezzi@gmail.com.
Purpose:
The objective of this study is to evaluate whether the modified HoLEP technique can preserve antegrade ejaculation. The secondary objective is to assess postoperative prostatic symptoms and whether post-surgical ejaculatory function causes discomfort in patients.
Methods:
A prospective randomized study was conducted, including patients who underwent HoLEP at Hospital Italiano de Buenos Aires during 7 months. Patients were prospectively allocated to two groups; one group underwent the standard HoLEP technique, while the other underwent the modified technique (preservation 1 cm of peri-veru-montanum tissue). The study concluded 6 months post-surgery. Validated questionnaires (IPSS and "MSHQ-EjD Short Form") were used to evaluate prostatic symptoms and ejaculatory function.
Results:
75 patients met the inclusion criteria. Patients were divided into two groups: Group A (37 patients) did not preserve peri-veru-montanum tissue, while Group B (38 patients) did. The mean change in IPSS for Group A was 13.9 (SD 5.9), and for Group B 14.2 (SD 6.2) (p = 0.835). The mean change in ejaculatory function was 7.5 (SD 5.2) for Group A and 8.1 (SD 4.1) for Group B (p = 0.619). 50 (66.6%) patients reported feeling "not at all" or "a little" bothered by their ejaculatory function post-surgery, while 12 (16%) patients reported feeling "very" or "extremely" bothered.
Conclusion:
Preservation of peri-verumontanum tissue during HoLEP was not associated with improved preservation of antegrade ejaculation compared with the standard technique. Both groups showed significant improvement in lower urinary tract symptoms.
