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Ejaculation-sparing versus non-ejaculation-sparing anatomic GreenLight laser enucleo-vaporization of the prostate: first comparative study

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Abstract

Purpose

To present the step-by-step description of an ejaculation-sparing anatomic photo-selective vaporization of the prostate (PVP) technique. To report the results of a series of ejaculation-sparing versus non-ejaculation-sparing anatomic PVPs.

Methods

Sexually active, benign prostatic hyperplasia (BPH) patients undergoing an anatomic PVP between 11/2018 and 2/2020 were included. Patients were divided into group A (ejaculation-sparing surgery) and group B (control group). Baseline, peri-operative and 6-months follow-up data were evaluated. Lower urinary tract symptoms (LUTS) and sexual function were assessed through internationally validated questionnaires. Groups were matched by an inverse probability of treatment weighting (IPTW) analysis. Logistic univariable regression analysis was performed to detect predictors of antegrade ejaculation preservation.

Results

Overall, 76 patients were included, among which 15 in group A and 61 in group B. Median (inter-quartile range, IQR) age was 72 (66.5–77) years, median (IQR) prostate volume 63.5 (54.5–98.5) cc. No differences about peri-operative outcomes were detected, included high-grade complications. At 6-months follow-up, no differences in urinary or erectile function were detected between groups, while ejaculation-sparing patients showed better Male Sexual Health Questionnaire (MSHQ) scores [7 (1–13) vs. 1 (1–1), p < 0.001] and higher rates of antegrade ejaculation (60% vs. 13.1%, p < 0.001). The ejaculation-sparing technique was identified as a predictor of post-operative antegrade ejaculation (OR 19.3, CI 95% 7.2–51.2, p < 0.001).

Conclusion

The ejaculation-sparing anatomic PVP showed superiority over the control group in post-operative ejaculatory function scores and antegrade ejaculation rates. Besides, preliminary results suggested similar effectiveness in LUTS relief at a short-term follow-up.

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

Authors

Contributions

Surgical technique development and manuscript editing: PD and PG. Manuscript writing: MS and FS. Data collection: MS, EV, FV, AB, AB, and BL.

Corresponding author

Correspondence to Mattia Sibona.

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Conflict of interest

Destefanis Paolo: Dr. Destefanis carried out retributed tutoring activities for DBI Italy (GreenLight® tutoring program); Sibona Mattia, Soria Francesco, Vercelli Eugenia, Vitiello Federico, Bisconti Alessandro, Bosio Andrea, Lillaz Beatrice and Gontero Paolo have no conflicts of interest to disclose.

Ethical approval

The IRB approval (retrospective studies) was obtained. The study was conducted accordingly to the principles of the Helsinki declaration and its later amendments or comparable ethical standards.

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All patients signed an informed consent before surgery.

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All patients gave their consent for the publication of this article.

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Destefanis, P., Sibona, M., Soria, F. et al. Ejaculation-sparing versus non-ejaculation-sparing anatomic GreenLight laser enucleo-vaporization of the prostate: first comparative study. World J Urol 39, 3455–3463 (2021). https://doi.org/10.1007/s00345-021-03615-7

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  • DOI: https://doi.org/10.1007/s00345-021-03615-7

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