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.

  • Review Article
  • Published:

The impact of surgery for lower urinary tract symptoms/benign prostatic enlargement on both erectile and ejaculatory function: a systematic review

International Journal of Impotence Research volume 31, pages 319–327 (2019)Cite this article

Subjects

Abstract

We performed a systematic review of studies evaluating the impact of surgery for lower urinary tract symptoms suggestive of benign prostate enlargement (LUTS/BPE) on both erectile and ejaculatory functions. In June 2018, we searched for randomized controlled trials (RCTs) published between 1998 and 2018 in which both functions were assessed using questionnaires. Overall, 15 studies were identified. Pre-operatively, mean International Index of Erectile Function −5 (IIEF-5) and mean IIEF—Erectile Function (EF) scores ranged from 13.3 to 20.8, and from 13.7 to 22.3, respectively. At follow-up evaluations, mean IIEF-5 and mean IIEF-EF scores did not significantly vary (13.4 to 20.7 and 14.4 to 24.3, respectively). Mean baseline Male Sexual Health Questionnaire- Ejaculatory Disease function score at baseline and follow-up evaluations ranged from 8.7 to 10.6, and from 4.9 to 11.9, respectively. Ejaculatory function significantly worsened in three studies after transurethral resection of the prostate and significantly improved in 2 studies after prostate urethral lift implant. In conclusions, available RCTs evaluating both erectile and ejaculatory functions after surgical procedures for LUTS/BPE fail to demonstrate significant variations in terms of erectile function scores while providing significant variations of ejaculatory function scores that are heterogeneous depending on the procedure adopted.

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

Fig. 1

Similar content being viewed by others

References

  1. Trueman P, Hood SC, Nayak US, Mrazek MF. Prevalence of lower urinary tract symptoms and self-reported diagnosed ‘benign prostatic hyperplasia’, and their effect on quality of life in a community-based survey of men in the UK. BJU Int. 1999;83:410–5.

    Article  CAS  Google Scholar 

  2. Boyle P, Robertson C, Mazzetta C, Keech M, Hobbs FD, Fourcade R, et al. The prevalence of lower urinary tract symptoms in men and women in four centres. The UrEpik study. BJU Int. 2003;92:409–14.

    Article  CAS  Google Scholar 

  3. Logie J, Clifford GM, Farmer RD. Incidence, prevalence and management of lower urinary tract symptoms in men in the UK. BJU Int. 2005;95:557–62.

    Article  Google Scholar 

  4. Li Z, Chen P, Wang J, Mao Q, Xiang H, Wang X, et al. The impact of surgical treatments for lower urinary tract symptoms/benign prostatic hyperplasia on male erectile function: A systematic review and network meta-analysis. Medicine. 2016;95:e3862.

    Article  Google Scholar 

  5. Herberts M, Butcher M, Köhler T. The effect of LUTS/BPH and treatments on ejaculatory function. Curr Urol Rep. 2016;17:48.

    Article  Google Scholar 

  6. Fusco F, Creta M, Imperatore V, Longo N, Imbimbo C, Lepor H, et al. Benign prostatic obstruction relief in patients with lower urinary tract symptoms suggestive of benign prostatic enlargement undergoing endoscopic surgical procedures or therapy with alpha-blockers: a review of urodynamic studies. Adv Ther. 2017;34:773–83.

    Article  Google Scholar 

  7. Creta M, Bottone F, Sannino S, Maisto E, Franco M, Mangiapia F, et al. Effects of alpha1-blockers on urodynamic parameters of bladder outlet obstruction in patients with lower urinary tract symptoms suggestive of benign prostatic enlargement: a review. Minerva Urol Nefrol. 2016;68:209–21.

  8. Rosen RC, Fitzpatrick JM, ALF-LIFE Study Group. Ejaculatory dysfunction in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. BJU Int. 2009;104:974–83.

    Article  Google Scholar 

  9. Francisca EA, d’Ancona FC, Meuleman EJ, Debruyne FM, de la Rosette JJ. Sexual function following high energy microwave thermotherapy: results of a randomized controlled study comparing transurethral microwave thermotherapy to transurethral prostatic resection. J Urol. 1999;161:486–90.

    Article  CAS  Google Scholar 

  10. Brookes ST, Donovan JL, Peters TJ, Abrams P, Neal DE. Sexual dysfunction in men after treatment for lower urinary tract symptoms: evidence from randomised controlled trial. Br Med J. 2002;324:1059–61.

    Article  Google Scholar 

  11. 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;44:637–49.

    Article  Google Scholar 

  12. Miner M, Rosenberg MT, Perelman MA. Treatment of lower urinary tract symptoms in benign prostatic hyperplasia and its impact on sexual function. Clin Ther. 2006;28:13–25.

    Article  Google Scholar 

  13. Martínez-Jabaloyas JM, Villamón-Fort R, Gil-Salom M, Chuan-Nuez P. Impact of benign prostatic hyperplasia surgery on erectile function. Urol Int. 2010;84:407–12.

    Article  Google Scholar 

  14. Marra G, Sturch P, Oderda M, Tabatabaei S, Muir G, Gontero P. Systematic review of lower urinary tract symptoms/benign prostatic hyperplasia surgical treatments on men’s ejaculatory function: Time for a bespoke approach? Int J Urol. 2016;23:22–35.

    Article  Google Scholar 

  15. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analysis of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009;151:65–94.

    Article  Google Scholar 

  16. Jadad AR. Randomised controlled trials. London, UK: BMJ Publishing Group; 1998.

    Google Scholar 

  17. Tuhkanen K, Heino A, Aaltoma S, Ala-Opas M. Sexual function of LUTS patients before and after neodymium laser prostatectomy and transurethral resection of prostate. A prospective, randomized trial. Urol Int. 2004;73:137–42.

    Article  Google Scholar 

  18. 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. 2004;172(5 Pt 1):1926–9.

    Article  Google Scholar 

  19. Fowler C, McAllister W, Plail R, Karim O, Yang Q. Randomised evaluation of alternative electrosurgical modalities to treat bladder outflow obstruction in men with benign prostatic hyperplasia. Health Technol Assess. 2005;9:1–30. iii–iv

    Article  Google Scholar 

  20. 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;175:1817–21.

    Article  Google Scholar 

  21. Elmansy HM, Elzayat E, Elhilali MM. Holmium laser ablation versus photoselective vaporization of prostate less than 60 cc: long-term results of a randomized trial. J Urol. 2010;184:2023–8.

    Article  Google Scholar 

  22. Lukacs B, Loeffler J, Bruyère F, Blanchet P, Gelet A, Coloby P, et al. Photoselective vaporization of the prostate with GreenLight 120-W laser compared with monopolar transurethral resection of the prostate: a multicenter randomized controlled trial. Eur Urol. 2012;61:1165–73.

    Article  Google Scholar 

  23. 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;112:109–20.

    Article  Google Scholar 

  24. Roehrborn CG, Gange SN, Shore ND, Giddens JL, Bolton DM, Cowan BE, et al. The prostatic urethral lift for the treatment of lower urinary tract symptoms associated with prostate enlargement due to benign prostatic hyperplasia: the L.I.F.T. Study. J Urol. 2013;190:2161–7.

    Article  Google Scholar 

  25. Roehrborn CG, Rukstalis DB, Barkin J, Gange SN, Shore ND, Giddens JL, et al. Three year results of the prostatic urethral L.I.F.T. study. Can J Urol. 2015;22:7772–82.

    Google Scholar 

  26. Sønksen J, Barber NJ, Speakman MJ, Berges R, Wetterauer U, Greene D, et al. Prospective, randomized, multinational study of prostatic urethral lift versus transurethral resection of the prostate: 12-month results from the BPH6 study. Eur Urol. 2015;68:643–52.

    Article  Google Scholar 

  27. McVary KT, Gange SN, Gittelman MC, Goldberg KA, Patel K, Shore ND, et al. Erectile and Ejaculatory Function Preserved With Convective Water Vapor Energy Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: Randomized Controlled Study. J Sex Med. 2016;13:924–33.

    Article  Google Scholar 

  28. Gratzke C, Barber N, Speakman MJ, Berges R, Wetterauer U, Greene D, et al. Prostatic urethral lift vs transurethral resection of the prostate: 2-year results of the BPH6 prospective, multicentre, randomized study. BJU Int. 2017;119:767–75.

    Article  Google Scholar 

  29. Gilling P, Barber N, Bidair M, Anderson P, Sutton M, Aho T, et al. WATER: a double-blind, randomized, controlled trial of Aquablation® vs transurethral resection of the prostate in benign prostatic hyperplasia. J Urol. 2018;199:1252–61.

    Article  Google Scholar 

  30. Fusco F, Arcaniolo D, Creta M, Piccinocchi G, Arpino G, Laringe M, et al. Demographic and comorbidity profile of patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia in a real-life clinical setting: are 5-alpha-reductase inhibitor consumers different? World J Urol. 2015;33:685–9.

    Article  CAS  Google Scholar 

  31. Rosen RC, Giuliano F, Carson CC. Sexual dysfunction and lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Eur Urol. 2005;47:824–37.

    Article  Google Scholar 

  32. Imbimbo C, Creta M, Gacci M, Simonato A, Gontero P, de Cobelli O, et al. Patients’ desire to preserve sexual activity and final decision for a nerve-sparing approach: results from the MIRROR (Multicenter Italian Report on Radical Prostatectomy Outcomes and Research) Study. J Sex Med. 2011;8:1495–502.

    Article  Google Scholar 

  33. 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;49:822–30.

    Article  CAS  Google Scholar 

  34. Rosen RC, Catania J, Pollack L, Althof S, O’Leary M, Seftel AD. Male Sexual Health Questionnaire (MSHQ): scale development and psychometric validation. Urology. 2004;64:777–82.

    Article  Google Scholar 

  35. Lukacs B. Assessment of male sexual function. Prostate Cancer Prostatic Dis. 2001;4(S1):S7–S11.

    Article  CAS  Google Scholar 

  36. Donovan JL, Abrams P, Peters TJ, Kay HE, Reynard J, Chapple C. The ICS-‘BPH’ Study: the psychometric validity and reliability of the ICSmale questionnaire. Br J Urol. 1996;77:554–62.

    Article  CAS  Google Scholar 

  37. 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;58:207–11.

    Article  Google Scholar 

  38. Soleimani M, Hosseini SY, Aliasgari M, Dadkhah F, Lashay A, Amini E. Erectile dysfunction after prostatectomy: an evaluation of the risk factors. Scand J Urol Nephrol. 2009;43:277–81.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosciences, reproductive sciences and odontostomatology—Urology Unit, University Federico II of Naples, Naples, Italy

    Paolo Verze, Gianluigi Califano & Massimiliano Creta

  2. Department of Urology and Pediatric Urology, Julius-Maximilians University of Würzburg, Würzburg, Germany

    Ioannis Sokolakis & Georgios Hatzichristodoulou

  3. Urology Section, University of Catania, Catania, Italy

    Giorgio Ivan Russo

  4. Urology Department, Istituto Europeo di Oncologia (I.E.O.), Milan, Italy

    Gennaro Musi

Authors
  1. Paolo Verze
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gianluigi Califano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ioannis Sokolakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giorgio Ivan Russo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Georgios Hatzichristodoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gennaro Musi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Massimiliano Creta
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

on behalf of the EAU-YAU Men’s health working party

Corresponding author

Correspondence to Paolo Verze.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Verze, P., Califano, G., Sokolakis, I. et al. The impact of surgery for lower urinary tract symptoms/benign prostatic enlargement on both erectile and ejaculatory function: a systematic review. Int J Impot Res 31, 319–327 (2019). https://doi.org/10.1038/s41443-019-0140-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41443-019-0140-0

This article is cited by

Search

Advanced search

Quick links