Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Long-term sexual outcomes after holmium laser enucleation of the prostate: which patients could benefit the most?

International Journal of Impotence Research volume 28, pages 189–193 (2016)Cite this article

Subjects

Abstract

Assess rate and predictors of erectile function (EF) outcomes at long-term follow-up (FU) after holmium laser enucleation of the prostate (HoLEP). Cross-sectional analyses were performed on 135 patients with a mean FU of 12 years post HoLEP. Patients completed both a baseline and a FU International Index of Erectile Function (IIEF)-EF domain and the International Prostatic Symptoms Score (IPSS). Postoperative EF outcomes, including rate and predictors of EF improvement considering minimal clinically important differences (MCIDs) criteria, were assessed. Logistic regression models tested the association between predictors and EF. At a mean (median) FU of 152.1 (163) months, patients showed a significant decrease in the IIEF-EF score P<0.01) and significant IPSS improvement (P<0.01). Overall, 50 (37%) patients worsened by at least one IIEF-EF category. Conversel, 23 (17%) patients reported an improvement in postoperative IIEF-EF score; 75 (55.6%) and 10 (7.4%) patients maintained and eventually improved their IIEF-EF category, respectively. Patients reporting a decrease in the postoperative IIEF-EF score were significantly older (P=0.03) and showed a significantly longer mean FU (P<0.01) than those reporting postoperative improvements of IIEF-EF. Nine (6.7%) patients showed significant EF improvement according to MCIDs criteria. Both higher IPSS scores (odds ratio (OR): 1.12; P=0.02) and lower IIEF-EF (OR: 0.88; P<0.01) at baseline, emerged as independent predictors of postoperative EF improvement. HoLEP was associated with a decrease in EF and a persistent amelioration of BPH-related urinary symptoms at long-term FU. Almost one third of patients worsened by at least one IIEF-EF category. However, a clinically meaningful EF improvement was observed in roughly 7% of the individuals. Patients with more severe preoperative urinary symptoms and ED benefited more from HoLEP in terms of EF.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Gacci M, Eardley I, Giuliano F, Hatzichristou D, Kaplan SA, Maggi M et al. Critical analysis of the relationship between sexual dysfunctions and lower urinary tract symptoms due to benign prostatic hyperplasia. Eur Urol 2011; 60: 809–815.

    Article  Google Scholar 

  2. Briganti A, Naspro R, Gallina A, Salonia A, Vavassori I, Hurle R et al. Impact on sexual function of Holmium laser enucleation versus transurethral resection of the prostate: results of a prospective, 2-center, randomized trial. J Urol 2006; 175: 1817–1821.

    Article  Google Scholar 

  3. Bruyère F, Puichaud A, Pereira H, Faivre d'Arcier B, Rouanet A, Floc'h AP et al. Influence of photoselective vaporization of the prostate on sexual function: results of a prospective analysis of 149 patients with long-term follow-up. Eur Urol 2010; 58: 207–211.

    Article  Google Scholar 

  4. Gilling PJ, Wilson LC, King CJ, Westenberg AM, Frampton CM, Fraundorfer MR . Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years. BJU Int 2012; 109: 408–411.

    Article  Google Scholar 

  5. Jeong MS, Ha SB, Lee CJ, Cho MC, Kim SW, Paick JS . Serial changes in sexual function following holmium laser enucleation of the prostate: a short-term follow-up study. Korean J Urol 2012; 53: 104–108.

    Article  Google Scholar 

  6. Mamoulakis C, Skolarikos A, Schulze M, Scoffone CM, Rassweiler JJ, Alivizatos G et al. Bipolar vs monopolar transurethral resection of the prostate: evaluation of the impact on overall sexual function in an international randomized controlled trial setting. BJU Int 2013; 112: 109–120.

    Article  Google Scholar 

  7. Muntener M, Aellig S, Kuettel R, Gehrlach C, Sulser T, Strebel RT . Sexual function after transurethral resection of the prostate (TURP): results of an independent prospective multicentre assessment of outcome. Eur Urol 2007; 52: 510–515.

    Article  Google Scholar 

  8. Oelke M, Bachmann A, Descazeaud A, Emberton M, Gravas S, Michel MC et al. European Association of Urology. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 2013; 64: 118–140.

    Article  Google Scholar 

  9. Leliefeld HH, Stoevelaar HJ, McDonnell J . Sexual function before and after various treatments for symptomatic benign prostatic hyperplasia. BJU Int 2002; 89: 208–213.

    Article  CAS  Google Scholar 

  10. Zong HT, Peng XX, Yang CC, Zhang Y . The impact of transurethral procedures for benign prostate hyperplasia on male sexual function: a meta-analysis. J Androl 2012; 33: 427–434.

    Article  Google Scholar 

  11. Elmansy HM, Kotb A, Elhilali MM . Holmium laser enucleation of the prostate: long-term durability of clinical outcomes and complication rates during 10 years of followup. J Urol 2011; 186: 1972–1976.

    Article  Google Scholar 

  12. Kuntz RM, Lehrich K, Ahyai SA . Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol 2008; 53: 160–166.

    Article  Google Scholar 

  13. Montorsi F, Naspro R, Salonia A, Suardi N, Briganti A, Zanoni M et al. Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center prospective randomized trial in patients with obstructive benign prostatic hyperplasia. J Urol 2008; 179: S87–S90.

    PubMed  Google Scholar 

  14. Naspro R, Bachmann A, Gilling P, Kuntz R, Madersbacher S, Montorsi F et al. A review of the recent evidence (2006–2008) for 532-nm photoselective laser vaporisation and holmium laser enucleation of the prostate. Eur Urol 2009; 55: 1345–1357.

    Article  Google Scholar 

  15. Kuntz RM, Ahyai S, Lehrich K, Fayad A . Transurethral holmium laser enucleation of the prostate versus transurethral electrocautery resection of the prostate: a randomized prospective trial in 200 patients. J Urol 2004; 172: 1012–1016.

    Article  Google Scholar 

  16. Rosen RC, Allen KR, Ni X, Araujo AB . Minimal clinically important differences in the erectile function domain of the International Index of Erectile Function scale. Eur Urol 2011; 60: 1010–1016.

    Article  Google Scholar 

  17. Charlson ME, Pompei P, Ales KL, MacKenzie CR . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373–383.

    Article  CAS  Google Scholar 

  18. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A . The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997; 49: 822–830.

    Article  CAS  Google Scholar 

  19. Cappelleri JC, Rosen RC, Smith MD, Mishra A, Osterloh IH . Diagnostic evaluation of the erectile function domain of the International Index of Erectile Function. Urology 1999; 54: 346–351.

    Article  CAS  Google Scholar 

  20. Elshal AM, Elmansy HM, Elkoushy MA, Elhilali MM . Male sexual function outcome after three laser prostate surgical techniques: a single center perspective. Urology 2012; 80: 1098–1104.

    Article  Google Scholar 

  21. Gacci M, Bartoletti R, Figlioli S, Sarti E, Eisner B, Boddi V et al. Urinary symptoms, quality of life and sexual function in patients with benign prostatic hypertrophy before and after prostatectomy: a prospective study. BJU Int 2003; 91: 196–200.

    Article  CAS  Google Scholar 

  22. Martínez-Jabaloyas JM, Villamón-Fort R, Gil-Salom M, Gil-Salom M, Chuan-Nuez P . Impact of benign prostatic hyperplasia surgery on erectile function. Urol Int 2010; 84: 407–412.

    Article  Google Scholar 

  23. Mebust WK, Holtgrewe HL, Cockett AT, Peters PC . Transurethral prostatectomy: immediate and postoperative complications. A cooperative study of 13 participating institutions evaluating 3,885 patients. J Urol 1989; 141: 243–247.

    Article  CAS  Google Scholar 

  24. Madersbacher S, Marberger M . Is transurethral resection of the prostate still justified? BJU Int 1999; 83: 227–237.

    Article  CAS  Google Scholar 

  25. Choi SB, Zhao C, Park JK . The effect of transurethral resection of the prostate on erectile function in patients with benign prostatic hyperplasia. Korean J Urol 2010; 51: 557–560.

    Article  Google Scholar 

  26. Guo Z, Jin X . The volume of prostate can impact the male sexual function following photoselective vaporization of the prostate: results of a prospective analysis of 128 patients with 2-year follow-up. Int Urol Nephrol 2013; 45: 961–966.

    Article  Google Scholar 

  27. Meng F, Gao B, Fu Q, Chen J, Liu Y, Shi B et al. Change of sexual function in patients before and after Ho:YAG laser enucleation of the prostate. J Androl 2007; 28: 259–261.

    Article  Google Scholar 

  28. Kim SH, Yang HK, Lee HE, Paick JS, Oh SJ . HoLEP does not affect the overall sexual function of BPH patients: a prospective study. Asian J Androl 2014; 16: 873–877.

    Article  Google Scholar 

  29. Placer J, Salvador C, Planas J, Trilla E, Lorente D, Celma A et al. Effects of holmium laser enucleation of the prostate on sexual function. J Endourol 2015; 29: 332–339.

    Article  Google Scholar 

  30. Rosen R, Altwein J, Boyle P, Kirby RS, Lukacs B, Meuleman E et al. Lower urinary tract symptoms and male sexual dysfunction: the multinational survey of the aging male (MSAM-7). Eur Urol 2003; 44: 637–649.

    Article  Google Scholar 

  31. Seftel AD, de la Rosette J, Birt J, Porter V, Zarotsky V, Viktrup L . Coexisting lower urinary tract symptoms and erectile dysfunction: a systematic review of epidemiological data. Int J Clin Pract 2013; 67: 32–45.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank Dana Kuefner PhD for reviewing the language in this manuscript.

Author information

Authors and Affiliations

  1. Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy

    P Capogrosso, F Montorsi & A Salonia

  2. Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, University vita-Salute San Raffaele, Milan, Italy

    P Capogrosso, E Ventimiglia, M Ferrari, A Serino, L Boeri, U Capitanio, A Briganti, F Montorsi & A Salonia

  3. Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy

    A Briganti & R Damiano

Authors
  1. P Capogrosso
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E Ventimiglia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M Ferrari
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A Serino
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. L Boeri
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. U Capitanio
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A Briganti
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. R Damiano
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. F Montorsi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. A Salonia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A Salonia.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Capogrosso, P., Ventimiglia, E., Ferrari, M. et al. Long-term sexual outcomes after holmium laser enucleation of the prostate: which patients could benefit the most?. Int J Impot Res 28, 189–193 (2016). https://doi.org/10.1038/ijir.2016.29

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijir.2016.29

This article is cited by

Search

Advanced search

Quick links