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A Review of Male Sexual Health and Dysfunction Following Surgical Treatment for Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms

  • Men's Health (A Dabaja, Section Editor)
  • Published:
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Abstract

Purpose of Review

Review how the various surgical treatments for benign prostatic hyperplasia and lower urinary tract symptoms impact on male sexual health and function.

Recent Findings

The interplay between benign prostatic hyperplasia and erectile function is complex, and the conditions seem linked. Most cavitating procedures to improve male voiding will degrade ejaculatory and possibly erectile function. Many of the newer minimally invasive therapies appear to preserve sexual function in the short term while sacrificing some of the voiding improvements realized with more complete removal of the prostate adenoma.

Summary

Benign prostatic hyperplasia will affect the majority of men at some point in life, and surgical treatment remains an integral option for managing the associated urinary symptoms. These treatments are associated with variable rates of sexual side effects, including ejaculatory, erectile, and orgasmic dysfunction. As the impact of these treatment modalities on sexual dysfunction has become more widely acknowledged, there has been a rise in interest in modalities that minimize adverse sexual side effects. Recent studies have sought to further elucidate the relationship between surgical treatment of benign prostate hyperplasia and sexual outcomes, and a number of studies have demonstrated that treatment of benign prostate hyperplasia can actually result in improved sexual function for some patients. This work intends to review the proposed pathophysiology behind the sexual side effects resulting from the surgical treatment of benign prostate hyperplasia and review the literature regarding both established and emerging surgical techniques.

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References

Papers of Particular Interest, Published Recently, Have Been Highlighted as: • Of Importance •• Of Major Importance

  1. •• Becher EF, McVary KT. Surgical procedures for BPH/LUTS: impact on male sexual health. Sex Med Rev. 2014;2(1):47–55. Contemporary review of the impact on sexual function of BPH treatments.

    Article  PubMed  Google Scholar 

  2. Braun M, Wassmer G, Klotz T, Reifenrath B, Mathers M, Engelmann U. Epidemiology of erectile dysfuntion: results of the Cologne Surgey. Int J Impot Res. 2000;12:305–11.

    Article  PubMed  CAS  Google Scholar 

  3. 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(6):637–49.

    Article  PubMed  Google Scholar 

  4. Benjamin Gozalez-Sanchez JC-G, Alejandro Rivera-Ramirez J, Herrera-Caceres JO, Olvera-Posada D, Villeda-Sandoval CI, Castillejos-Molina RA, et al. The correlation between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED): results from a survey in males from Mexico City (MexiLUTS). World J Urol. 2016;34:979–83.

    Article  Google Scholar 

  5. McVary KT. Erectile dysfunction and lower urinary tract symptoms secondary to BPH. Eur Urol. 2005;47(6):838–45.

    Article  PubMed  Google Scholar 

  6. Wein AJ, Kavoussi LR, Partin AW, Peters CA. Campbell-Walsh Urology. 11th Edn. Elsevier; 2016. P4176.

  7. Jaidane M, Arfa NB, Hmida W, Hidoussi A, Slama A, Sorba NB, et al. Effect of transurethral resection of the prostate on erectile function: a prospective comparative study. Int J Impot Res. 2010;22(2):146–51.

    Article  PubMed  CAS  Google Scholar 

  8. Kunelius P, Häkkinen J, Lukkarinen O. Sexual functions in patients with benign prostatic hyperplasia before and after transurethral resection of the prostate. Urol Res. 1998;26:7–9.

    Article  PubMed  CAS  Google Scholar 

  9. Muntener M, Aellig S, Kuettel R, Gehrlach C, Sulser T, Strebel RT. Sexual function after transurethral resection of the prostate (TURP): results of an independent prospective multicentre assessment of outcome. Eur Urol. 2007;52(2):510–5.

    Article  PubMed  Google Scholar 

  10. Roehrborn CG, McConnell JD, Barry MJ, Benaim E, Bruskewitz RC, Blute ML, Holtgrewe HL, Kaplan SA, Lang JL, Lowe FC, Roberts RG, Stein BS. AUA Guideline on the Management of Benign Prostatic Hyperplasia. 2003.

  11. Madersbacher S, Marberger M. Is Transurethral resection of the prostate still justifed? Br J Urol. 1999;83(3):227–37.

    Article  CAS  Google Scholar 

  12. Choi SB, Zhao C, Park JK. The effect of transurethral resection of the prostate on erectile function in patients with benigh prostatic hyperplasia. Korean J Urol. 2010;51:557–60.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Arai Y, Aoki Y, Okubo K, et al. Impact of interventional therapy for benign prostatic hyperplasia on quality of life and sexual function: a prospective study. J Urol. 2000;164:1206–11.

    Article  PubMed  CAS  Google Scholar 

  14. Poulakis V, Ferakis N, Witzsch U, de Vries R, Becht E. Erectile dysfunction after transurethral prostatectomy for lower urinary tract symptoms: results from a center with over 500 patients. Asian J Androl. 2006;8(1):69–74.

    Article  PubMed  Google Scholar 

  15. Soderdahl DW, Knight RW, Hansberry KL. Erectile dysfunction following transurethral resection of the prostate. J Urol. 1996;156:1354–6.

    Article  PubMed  CAS  Google Scholar 

  16. Akman T, Binbay M, Tekinarslan E, et al. Effectds of bipolar and monopolar transurethral resectino of the prostate on urinary and erectile function: a prospective randomized comparative study. BJU Int. 2013;111:126–36.

    Article  Google Scholar 

  17. 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  PubMed  Google Scholar 

  18. Wasson JH, Reda DJ, Bruskewitz RC, Elinson J, Keller A, Henderson W. A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia. The Veterans Affairs Cooperative Study Group on Transurethral Resection of the Prostate. N Engl J Med. 1995;332(2):75–9.

  19. 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 (Baltimore). 2016;95(24):e3862.

    Article  Google Scholar 

  20. Yang Q, Peters TJ, Donovan JL, Wilt TJ, Abrams P. Transurethral incision compared with transurethral resection of the prostate for bladder outlet obstruction: a systematic review and meta-analysis of randomized controlled trials. J Urol. 2001;165:1526–32.

    Article  PubMed  CAS  Google Scholar 

  21. Bruyere F, 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(2):207–11.

    Article  PubMed  Google Scholar 

  22. Hamann MF, Naumann CM, Seif C, van der Horst C, Jünemann KP, Braun PM. Functional outcome following photoselective vaporisation of the prostate (PVP): urodynamic findings within 12 months follow-up. Eur Urol. 2008;54(4):902–7.

    Article  PubMed  Google Scholar 

  23. Kavoussi PK, Hermans MR. Maintenance of erectile function after photoselective vaporization of the prostate for obstructive benign prostatic hyperplasia. J Sex Med. 2008;5(11):2669–71.

    Article  PubMed  Google Scholar 

  24. Bouchier-Hayes DM, van Appledorn S, Bugeja P, Crowe H, Challacombe B, Costello AJ. A randomized trial of photoselective vaporization of the prostate using the 80-W potassium-titanyl-phosphate laser vs transurethral prostatectomy, with a 1-year follow-up. BJU Int. 2010;105(7):964–9.

    Article  PubMed  Google Scholar 

  25. Pereira-Correia JA, de Moraes Sousa KD, Santos JBP, de Morais Perpétuo D, Lopes-da-Silva LF, Krambeck RL, et al. GreenLight HPS 120-W laser vaporization vs transurethral resection of the prostate (<60 mL): a 2-year randomized double-blind prospective urodynamic investigation. BJU Int. 2012;110(8):1184–9.

    Article  PubMed  Google Scholar 

  26. • Lukacs B, Loeffler J, Bruyere F, 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. Solid, multicenter randomized controlled trial comparing TURP and PVP with attention to the sexual side effects of each treatment, 1173.

    Article  PubMed  Google Scholar 

  27. • Cornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, et al. A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol. 2015;67(6):1066–96. Large meta-analysis comparing outcomes between TURP, HoLEP, PVP.

    Article  PubMed  Google Scholar 

  28. Fraundorfer MR, Gilling PJ. Holmium:YAG laser enucleation of the prostate combined with mechanical morcellation: preliminary results. Eur Urol. 1998;33(1):69–72.

    Article  PubMed  CAS  Google Scholar 

  29. 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(5):1817–21.

    Article  PubMed  Google Scholar 

  30. Kim JK, Cho MC, Son H, Ku JH, Oh SJ, Paick JS. Patient perception of ejaculatory volume reduction after holmium laser enucleation of the prostate (HoLEP). Urology. 2017;99:142–7.

    Article  PubMed  Google Scholar 

  31. Meng F, Gao B, Fu Q, Chen J, Liu Y, Shi B, et al. Change of sexual function in patients before and after Ho:YAG laser enucleation of the prostate. J Androl. 2007;28(2):259–61.

    Article  PubMed  Google Scholar 

  32. Elshal AM, el-Assmy A, Mekkawy R, Taha DE, el-Nahas AR, Laymon M, et al. Prospective controlled assessment of men’s sexual function changes following Holmium laser enucleation of the prostate for treatment of benign prostate hyperplasia. Int Urol Nephrol. 2017;49(10):1741–9.

    Article  PubMed  Google Scholar 

  33. Klett DE, Tyson MD II, Mmeje CO, Nunez–Nateras R, Chang YH, Humphreys MR. Patient-reported sexual outcomes after holmium laser enucleation of the prostate: a 3-year follow-up study. Urology. 2014;84(2):421–6.

    Article  PubMed  Google Scholar 

  34. Capogrosso P, Ventimiglia E, Ferrari M, Serino A, Boeri L, Capitanio U, et al. Long-term sexual outcomes after holmium laser enucleation of the prostate: which patients could benefit the most? Int J Impot Res. 2016;28(5):189–93.

    Article  PubMed  CAS  Google Scholar 

  35. Jeong MS, Ha SB, Lee CJ, Cho MC, Kim SW, Paick JS. Serial changes in sexual function following holmium laser enucleation of the prostate: a short-term follow-up study. Korean J Urol. 2012;53:104–8.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Tiburtius C, Knipper S, Gross AJ, Netsch C. Impact of thulium VapoEnucleation of the prostate on erectile function: a prospective analysis of 72 patients at 12-month follow-up. Urology. 2014;83:175–80.

    Article  PubMed  Google Scholar 

  37. Saredi G, Pacchetti A, Pirola GM, Martorana E, Berti L, Scroppo FI, et al. Impact of thulium laser enucleation of the prostate on erectile, ejaculatory and urinary functions. Urol Int. 2016;97:397–401.

    Article  PubMed  Google Scholar 

  38. Elshal AM, Elmansy HM, Elkoushy MA, Elhilali MM. Male sexual function outcome after three laser prostate surgical techniques: a single center perspective. Urology. 2012;80(5):1098–104.

    Article  PubMed  Google Scholar 

  39. Placer J, Salvador C, Planas J, Trilla E, Lorente D, Celma A, et al. Effects of holmium laser enucleation of the prostate on sexual function. J Endourol. 2015;29(3):332–9.

    Article  PubMed  Google Scholar 

  40. • Gilling PJ, Wilson LC, King CJ, Westenberg AM, Frampton CM, Fraundorfer MR. Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years. BJU Int. 2012;109(3):408–11. Small sample size, but one of the few studies evaluating sexual dysfunction outcomes over a longer time period, 411.

    Article  PubMed  Google Scholar 

  41. Bruskewitz R, et al. A prospective, randomized 1-year clinical trial comparing transurethral needle ablation to transurethral resection of the prostate for the treatment of symptomatic benign prostatic hyperplasia. J Urol. 1998;159(5):1588–93. discussion 1593–4

    Article  PubMed  CAS  Google Scholar 

  42. Cimentepe E, Unsal A, Saglam R. Randomized clinical trial comparing transurethral needle ablation with transurethral resection of the prostate for the treatment of benign prostatic hyperplasia: results at 18 months. J Endourol. 2003;17(2):103–7.

  43. Frieben RW, Lin HC, Hinh PP, Berardinelli F, Canfield SE, Wang R. The impact of minimally invasie surgeries for the treatment of symptomatic benign prostatic hyperplasia on male sexual function: a systematic review. Asian J Androl. 2010;12(4):500–8.

  44. Hill B, Belville W, Bruskewitz R, et al. Transurethral needle ablation versus transurethral resection of the prostate for the treatment of symptomatic benign prostatic hyperplasia: 5-year results of a prospective, randomized, multicenter clinical trial. J Urol. 2004;171: p:2336–40.

    Article  Google Scholar 

  45. 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.

  46. Mynderse LA, Roehrborn CG, Partin AW, Preminger GM, Coté EP. Results of a 5-year multicenter trial of a new generation cooled high energy transurethral microwave thermal therapy catheter for benign prostatic hyperplasia. J Urol. 2011;185(5):1804–10.

    Article  PubMed  Google Scholar 

  47. Hoffman RM, Monga M, Elliott SP, Macdonald R, Langsjoen J, Tacklind J, et al. Microwave thermotherapy for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2012;12(9):CD004135.

  48. • Roehrborn C, Barkin J, Gange SN, Giddens JL, Bolton DM, Cowan BE. Five year results of the prospective randomized controlled prostatic urethral L.I.F.T. study. Can J Urol. 2017;24(3):8802–13. 5-year results from prostatic urethral lift, showing the only minimal effect on sexual fucion of this techinque at short-intermediate follow-up.

    PubMed  Google Scholar 

  49. McVary K, Gange SN, Shore ND, Bolton DM, Cowan BE, Brown BT. Treatment of LUTS secondary to BPH while preserving sexual function: randomized controlled study of prostatic urethral lift. J Sex Med. 2014;11(1):279–87.

    Article  PubMed  Google Scholar 

  50. 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(5):767–75.

    Article  PubMed  Google Scholar 

  51. Perera M, Roberts MJ, Doi SAR, Bolton D. Prostatic urethral lift improves urinary symptoms and flow while preserving sexual function for men with benign prostatic hyperplasia: a systematic review and meta-analysis. Eur Urol. 2015;67(4):704–13.

    Article  PubMed  Google Scholar 

  52. Dixon C, Cedano ER, Pacik D, Vit V, Varga G, Wagrell L, et al. Efficacy and safety of Rezum system water vapor treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia. Urology. 2015;86(5):1042–7.

    Article  PubMed  Google Scholar 

  53. • McVary KT, Roehrborn CG. Three-year outcomes of the prospective, randomized controlled Rezum system study: convective radiofrequency thermal therapy for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Urology. 2018;111:1–9. 3-year results from convective water thermal therapy, showing the only minimal effect on sexual fucion of this techinque at short-term follow-up.

    Article  PubMed  Google Scholar 

  54. McVary KT, Gange SN, Gittelman MC, Goldberg KA, Patel K, Shore ND, et al. Minimally invasive prostate convective water vapor energy ablation: a multicenter, randomized, controlled study for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urol. 2016;195(5):1529–38.

    Article  PubMed  Google Scholar 

  55. 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 prostate in benign prostatic hyperplasia. J Urol. 2018;199:1252–61.

    Article  PubMed  Google Scholar 

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Correspondence to David A Leavitt.

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Alex Borchert declares no potential conflicts of interest.

David A Leavitt is a consultant and on the medical advisory board for Boston Scientific Company.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Borchert, A., Leavitt, D.A. A Review of Male Sexual Health and Dysfunction Following Surgical Treatment for Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms. Curr Urol Rep 19, 66 (2018). https://doi.org/10.1007/s11934-018-0813-0

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  • DOI: https://doi.org/10.1007/s11934-018-0813-0

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