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Do patients have to choose between ejaculation and miction? A systematic review about ejaculation preservation technics for benign prostatic obstruction surgical treatment

  • Souhil Lebdai 1,
  • Armand Chevrot 2,
  • Steeve Doizi 3,
  • Benjamin Pradere 4,
  • Nicolas Barry Delongchamps 5,
  • Amine Benchikh 6,
  • Jean Nicolas Cornu 7,
  • Emmanuel Della Negra 8,
  • Marc Fourmarier 9,
  • Vincent Misraï 10,
  • Pierre Etienne Theveniaud 11,
  • Aurélien Descazeaud 12,
  • Grégoire Robert 13
1 Urology Department, University Hospital of Angers, CHU Angers, Angers Cedex, France 2 Urology Department, University Hospital of Nimes, Nîmes, France 3 Urology Department, Hôpital Européen Georges Pompidou, Paris, France 4 Urology Department, University Hospital of Tours, Tours, France 5 Urology Department, University Hospital of Cochin, Paris, France 6 Urology Department, Clinique les Martinets, Versailles, France 7 Urology Department, University Hospital of Rouen, Rouen, France 8 Urology Department, Hôpital des Côtes d’Armor, Saint Brieuc, France 9 Urology Department, Hospital of Aix en Provence, Aix en Provence, France 10 Urology Department, Clinique Pasteur, Toulouse, France 11 Urology Department, Saint Joseph Hospital, Paris, France 12 Urology Department, University Hospital of Limoges, Limoges, France 13 Urology Department, University Hospital of Bordeaux, Bordeaux, France

Publication: World Journal of Urology, Volume 37, Issue 2, February 2019, Pages 299-308

Purpose

Ejaculatory dysfunction is the most common side effect related to surgical treatment of benign prostatic obstruction (BPO). Nowadays, modified surgical techniques and non-ablative techniques have emerged with the aim of preserving antegrade ejaculation. Our objective was to conduce a systematic review of the literature regarding efficacy on ejaculatory preservation of modified endoscopic surgical techniques, and mini-invasive non-ablatives techniques for BPO management.

Methods
A systematic review of the literature was carried out on the PubMed database using the following MESH terms: “Prostatic Hyperplasia/surgery” and “Ejaculation”, in combination with the following keywords: “ejaculation preservation”, “photoselective vaporization of the prostate”, “photoselective vapo-enucleation of the prostate”, “holmium laser enucleation of the prostate”, “thulium laser”, “prostatic artery embolization”, “urolift”, “rezum”, and “aquablation”.

Results
The ejaculation preservation rate of modified-TURP ranged from 66 to 91%. The ejaculation preservation rate of modified-prostate photo-vaporization ranged from 87 to 96%. The only high level of evidence studies available compared prostatic urethral lift (PUL) and aquablation versus regular TURP in prospective randomized-controlled trials. The ejaculation preservation rate of either PUL or aquablation compared to regular TURP was 100 and 90 versus 34%, respectively.

Conclusions
Non-ablative therapies and modified endoscopic surgical techniques seemed to be reasonable options for patients eager to preserve their ejaculatory functions.