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Editorial Comment on sexual side effects of surgery for BPE

International Journal of Impotence Research volume 31, pages 376–377 (2019)Cite this article

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Erectile Dysfunction (ED) and Ejaculatory Dysfunction (EjD) are common in men of all ages but the prevalence of these conditions tends to increase with age [1]. Benign Prostate Enlargement (BPE) is a condition most common in older men and a source of substantial morbidity and health care cost [2]. These conditions are often comorbid [3]. Given both the physical proximity of the prostate to the cavernous nerves and the essential role of the prostate in production of semen, it is not surprising that treatments for BPE tend to have sexual side effects. These effects range from troublesome but often manageable (e.g., failure of antegrade expulsion of semen with certain alpha blockers) [4] to debilitating (e.g., ED after transurethral resection of the prostate, TURP) [5]. As urologists perform an increasingly diverse number of surgical treatments that may simultaneously help BPH/voiding function while hindering sexual satisfaction, the timely and well-written manuscript by Verse et al. (“The impact of surgery for lower urinary tract symptoms/benign prostatic enlargement on both erectile and ejaculatory function: a systematic review”) provides useful guidance based on the latest evidence [6].

This review focuses on publications since 1998. To the authors credit an exhaustive list of surgeries was investigated, despite some being very infrequently used in contemporary practice and therefore of dubious clinical interest. Stringent criteria regarding study quality were utilized. While this makes the tables produced by the authors of great utility for comparison between treatments, the dearth of head to head comparisons in the published literature and the generally superficial nature of inquiry necessitate that any claims of superiority for one modality over another be interpreted with caution, particularly within categories (i.e., comparing surgical procedures with other surgical procedures, office-based procedures with other office-based procedures)

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Acknowledgements

Within the past 12 months I have received financial remuneration from the International Society of Sexual Medicine and the Sexual Medicine Society of North America. My spouse has received financial remuneration from International Society of Sexual Medicine, the International Society for Study of Women’s Sexual Health, and Symposia Medicus

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  1. Department of Urology, University of California, San Francisco, San Francisco, CA, USA

    Alan W. Shindel

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Correspondence to Alan W. Shindel.

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Shindel, A.W. Editorial Comment on sexual side effects of surgery for BPE. Int J Impot Res 31, 376–377 (2019). https://doi.org/10.1038/s41443-019-0156-5

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