Erectile and ejaculatory outcomes after HoLEP: A longitudinal analysis during the learning curve

Holmium laser enucleation of the prostate (HoLEP) is a well-established surgical technique for benign prostatic obstruction. Although functional outcomes have been widely reported, data on sexual function during the learning phase remain limited. The aim of this study was to describe longitudinal erectile and ejaculatory outcomes during the initial learning curve of HoLEP.

The first 254 consecutive patients undergoing HoLEP by a single surgeon were prospectively collected and retrospectively analyzed. Erectile function was evaluated using the Sexual Health Inventory for Men (SHIM) preoperatively and at 1, 3, 6, and 12 months. Ejaculatory function was assessed at the same intervals. Descriptive and comparative statistics were used, and patients were stratified into case groups to explore surgical experience impact.

A total of 254 patients were included. Mean patient age was 70.1 ±7.7 years and mean prostate volume was 90.9 ±34.4 cc. Preoperative SHIM scores were available for 222 patients, with a median of 12.7 [5.0-20.0]. SHIM decreased at 1 month (9 [3-15]) and recovered at 3 (12 [5-20]) and 6 months (13 [6-22]). At 12 months, erectile function remained stable (12 [5-20]) with no clinically relevant deterioration. Anejaculation was observed in 93.2% at 1 month and persisted throughout follow-up (>94%), with no significant differences across case groups.

In this real-world HoLEP series, erectile function was preserved at mid-term follow-up, with a high and persistent rate of anejaculation. Sexual outcomes did not appear influenced by surgical experience.