Serial Changes in Sexual Function Following Holmium Laser Enucleation of the Prostate: A Short-term Follow-up Study

다국어 초록 (Multilingual Abstract)

Purpose: To evaluate the serial changes in sexual function in the short-term period after holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia (BPH) and to investigate whether a change in each domain of the International Index of Erectile Function (IIEF) is associated with improvement of micturition.
Materials and Methods: Thirty-eight potent men who underwent HoLEP and in whom complete 12-month follow-up data on the IIEF were available were included in this retrospective study. All patients underwent a baseline evaluation for BPH. The surgical outcome was evaluated at 1, 3, 6, and 12 months postoperatively by use of the International Prostate Symptom Score, IIEF, and uroflowmetry.
Results: The mean age and body mass index of the patients was 64.5±6.2 years and 24.2±2.6 kg/m2, respectively. Mean total prostate volume and transitional zone volume were 48.8±18.8 ml and 24.2±16.1 ml, respectively. Most IIEF domain scores showed a slight decrease at 1, 3, and 6 months after surgery but recovered to the baseline or showed a marginal but nonsignificant increase at 12 months postoperatively compared with baseline. Orgasmic function and the overall sexual satisfaction domain score remained slightly reduced up to 12 months postoperatively. There was no significant correlation between improvement of micturition and change in sexual function throughout the follow-up period after surgery.
Conclusions: Although HoLEP achieves significant improvements in micturition, overall sexual function decreases slightly in the early postoperative period, but recovers to the baseline at 12 months postoperatively. Our data suggest that changes in sexual function after HoLEP are not associated with improvement of micturition.

다국어 초록 (Multilingual Abstract)

Purpose: To evaluate the serial changes in sexual function in the short-term period after holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia (BPH) and to investigate whether a change in each domain of the International Index of Erectile Function (IIEF) is associated with improvement of micturition.
Materials and Methods: Thirty-eight potent men who underwent HoLEP and in whom complete 12-month follow-up data on the IIEF were available were included in this retrospective study. All patients underwent a baseline evaluation for BPH. The surgical outcome was evaluated at 1, 3, 6, and 12 months postoperatively by use of the International Prostate Symptom Score, IIEF, and uroflowmetry.
Results: The mean age and body mass index of the patients was 64.5±6.2 years and 24.2±2.6 kg/m2, respectively. Mean total prostate volume and transitional zone volume were 48.8±18.8 ml and 24.2±16.1 ml, respectively. Most IIEF domain scores showed a slight decrease at 1, 3, and 6 months after surgery but recovered to the baseline or showed a marginal but nonsignificant increase at 12 months postoperatively compared with baseline. Orgasmic function and the overall sexual satisfaction domain score remained slightly reduced up to 12 months postoperatively. There was no significant correlation between improvement of micturition and change in sexual function throughout the follow-up period after surgery.
Conclusions: Although HoLEP achieves significant improvements in micturition, overall sexual function decreases slightly in the early postoperative period, but recovers to the baseline at 12 months postoperatively. Our data suggest that changes in sexual function after HoLEP are not associated with improvement of micturition.

참고문헌 (Reference)

1 Kuntz RM, "Transurethral holmium laser enucleation of the prostate versus transurethral electrocautery resection of the prostate: a randomized prospective trial in 200 patients" 172 : 1012-1016, 2004

2 Boyle P, "The association between lower urinary tract symptoms and erectile dysfunction in four centres: the UrEpik study" 92 : 719-725, 2003

3 최성범, "The Effect of Transurethral Resection of the Prostate on Erectile Function in Patients with Benign Prostatic Hyperplasia" 대한비뇨기과학회 51 (51): 557-560, 2010

4 Leliefeld HH, "Sexual function before and after various treatment for symptomatic benign prostatic hyperplasia" 89 : 208-213, 2002

5 Muntener M, "Sexual function after transurethral resection of the prostate (TURP): results of an independent prospective multicentre assessment of outcome" 52 : 510-515, 2007

6 강정한, "Prevalence and correlates of erectile dysfunction by race and ethnicity among men aged 40 or older in the United States: From the Male Attitudes Regarding Sexual Health survey" 4 (4): 57-65, 200701

7 Cho MC, "Predictor of de novo urinary incontinence following holmium laser enucleation of the prostate" 30 : 1343-1349, 2011

8 Elliott SP, "Obstructive lower urinary tract symptoms correlate with erectile dysfunction" 63 : 1148-1152, 2004

9 Kavoussi PK, "Maintenance of erectile function after photoselective vaporization of the prostate for obstructive benign prostatic hyperplasia" 5 : 2669-2671, 2008

10 Rosen R, "Lower urinary tract symptoms and male sexual dysfunction: the multinational survey of the aging male (MSAM-7)" 44 : 637-649, 2003

11 Braun MH, "Lower urinary tract symptoms and erectile dysfunction: co-morbidity or typical “Aging male” symptoms? Results of the “Cologne Male Survey”" 44 : 588-594, 2003

12 Bruyère F, "Influence of photoselective vaporization of the prostate on sexual function: results of a prospective analysis of 149 patients with long-term follow-up" 58 : 207-211, 2010

13 Paick JS, "Influence of high-power potassium-titanyl-phosphate photoselective vaporization of the prostate on erectile function: a short-term follow-up study" 4 : 1701-1707, 2007

14 Tscholl R, "Incidence of erectile impotence secondary to transurethral resection of benign prostatic hyperplasia, assessed by preoperative and postoperative Snap Gauge tests" 153 : 1491-1493, 1995

15 Parsons CI, "Impotence following transurethral resection of the prostate, In Common problems in infertility and impotence" Year Book Medical 352-355, 1990

16 Briganti A, "Impact on sexual function of holmium laser enucleation versus transurethral resection of the prostate: results of a prospective, 2-center, randomized trial" 175 : 1817-1821, 2006

17 Costabile RA, "How can we best characterize the relationship between erectile dysfunction and benign prostatic hyperplasia?" 3 : 676-681, 2006

18 Naspro R, "Holmium laser enucleation the prostate versus open prostatectomy for prostates ＞70 g: 24-month follow-up" 50 : 563-568, 2006

19 Aho TF, "Holmium laser bladder neck incision versus holmium enucleation of the prostate as outpatient procedures for prostates less than 40 grams: a randomized trial" 174 : 210-214, 2005

20 Zohar J, "Factors influencing sexual activity after prostatectomy: a prospective study" 116 : 332-334, 1976

21 Uygur MC, "Erectile dysfunction following treatments of benign prostatic hyperplasia: a prospective study" 30 : 5-10, 1998

22 Poulakis V, "Erectile dysfunction after transurethral prostatectomy for lower urinary tract symptoms: Results from a center with over 500 patients" 8 : 69-74, 2006

23 Hoesl CE, "Erectile dysfunction (ED) is prevalent, bothersome and underdiagnosed in patients consulting urologists for benign prostatic syndrome (BPS)" 47 : 511-517, 2005

24 Cappelleri JC, "Diagnostic evaluation of the erectile function domain of the International Index of Erectile Function" 54 : 346-351, 1999

25 Meng F, "Change of sexual function in patients before and after Ho:YAG laser enucleation of the prostate" 28 : 259-261, 2007

26 Tan AH, "A randomized trial comparing holmium laser enucleation of the prostate with transurethral resection of the prostate for the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia in large glands (40 to 200 grams)" 170 : 1270-1274, 2003

27 Wasson JH, "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" 332 : 75-79, 1995