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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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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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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DOI: https://doi.org/10.1038/s41391-024-00834-y