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Ejaculation sparing of classic and minimally invasive surgical treatments of LUTS/BPH

Prostate Cancer and Prostatic Diseases (2024)Cite this article

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Abstract

Background

The surgical landscape for Lower Urinary Tract Symptoms (LUTS) and Benign Prostatic Hyperplasia (BPH) has evolved with the introduction of Minimally Invasive Surgical Therapies (MISTs), recognizing the impact of sexual function on patients’ well-being, and prioritizing ejaculation-sparing approaches.

Methods

This systematic review explored ejaculation sparing after classic endoscopic procedures and MISTs (iTind, Rezūm, Urolift, Aquablation, and TPLA) and a literature search yielded 41 studies.

Results

While all procedures demonstrated efficacy in improving LUTS/BPH symptoms (IPSS, QoL, Qmax), a subset of studies evaluated ejaculatory function. Positive outcomes were noted, challenging the historical association of BPH surgeries with ejaculatory dysfunction. Variations in study design, patient cohorts, and limited long-term data present challenges. Notably, the lack of baseline specificity, use of alpha-blockers, and non-specific sexual function assessments underscore potential biases.

Conclusions

Despite limitations, the review tentatively concluded that MISTs, including iTind, Rezūm, Urolift, Aquablation, and TPLA, appear comparable in sparing ejaculation. Long-term studies are essential to validate sustainability, and comparative research should assess trade-offs between MISTs and traditional surgeries. Incorporating patient-reported outcomes and quality of life assessments will enhance future investigations, refining MISTs as standard therapeutic options for LUTS/BPH.

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Fig. 1: Sistematic review flow diagram.

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Author notes

  1. These authors contributed equally: Gian Maria Busetto, Riccardo Lombardo.

Authors and Affiliations

  1. Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy

    Gian Maria Busetto, Edoardo Tocci, Nicola Schiavone & Giuseppe Carrieri

  2. Department of Urology, Sapienza University of Rome, Rome, Italy

    Riccardo Lombardo, Cosimo De Nunzio, Giuseppe Santoro & Andrea Tubaro

  3. Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Steven A. Kaplan

  4. Department of Urology, Spital Thurgau AG, Kantonspital Frauenfeld, Frauenfeld, Switzerland

    Thomas R. W. Herrmann

  5. Division of Urology, Department of Surgical Sciences, Stellenbosch University, Western Cape, Stellenbosch, South Africa

    Thomas R. W. Herrmann

  6. Hannover Medical School, Hannover, Germany

    Thomas R. W. Herrmann

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  1. Gian Maria Busetto
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Contributions

Conceptualization GMB and RL; Data curation GS, ET and NS; Formal analysis GMB and RL; Methodology AT, CDN and GC; Project administration AT, CDN and GC; Resources TRH and SAK; Supervision GMB, RL, TRH and SAK; Writing-original draft GS, ET and NS; Writing-review & editing GMB, RL and TRH. All authors have read and agreed to the published version of the manuscript.

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Correspondence to Gian Maria Busetto.

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Busetto, G.M., Lombardo, R., De Nunzio, C. et al. Ejaculation sparing of classic and minimally invasive surgical treatments of LUTS/BPH. Prostate Cancer Prostatic Dis (2024). https://doi.org/10.1038/s41391-024-00834-y

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