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Prostate size and its effect on sexual function following convective water vapor thermal therapy
Amandip Cheema1, Bronwyn Long1, Owen Lewer2
1Department of Urology, Loyola University Medical Center, Maywood, IL, USA.
Background/Objective:
Convective water vapor thermal therapy (CWVTT) effectively treats Lower Urinary Tract Symptoms (LUTS) from Benign Prostatic Hyperplasia (BPH). While sexual outcomes have been studied across BPH procedures, the influence of prostate size on sexual function after CWVTT is unclear. We aimed to determine whether preservation of sexual function, measured by the Sexual Health Inventory for Men (SHIM), differs by prostate volume, particularly in larger glands.
Subjects/Methods:
Following IRB approval, patients aged ≥18 undergoing CWVTT from October 2018 to August 2022 were identified by CPT codes 53,852 and 53,854. After applying inclusion/exclusion criteria, patients were stratified into prostate tertiles: small (≤38.5 cc), medium (38.5-55.6 cc), and large (>55.6 cc). SHIM scores were tracked longitudinally.
Results:
Baseline demographics were similar across tertiles. Mean SHIM change from baseline to 3 months was -1.02, -2.10, and -0.46 for small, medium, and large prostates, respectively; only the medium group showing a statistically significant decline. Beyond 3 months, SHIM scores improved across all tertiles. Large prostates demonstrated a significant increase in SHIM over time (+0.18/month, p = 0.01) though significance was lost after adjusting for age, comorbidities, and baseline SHIM. Severe baseline erectile dysfunction (ED) predicted the greatest postoperative improvement, while men with no ED experienced mild decline. Age and baseline SHIM were the strongest predictors of outcomes.
Conclusions:
Men with larger prostates who undergoe CWVTT do not appear at increased risk of ED. In fact, the men with larger prostates have a faster recovery of sexual function than other prostate sizes. Patients with severe ED should be counseled on the potential for improvement in their sexual function following their procedure, especially 3 months onward with the exact mechanism being unknown. Finally, prostate volume likely plays a role in timing of recovery, although it is overshadowed by the influence of baseline SHIM scores and age.
