[Impact of thulium laser enucleation of the prostate versus transurethral resection of the prostate on sexual function in patients with benign prostatic hyperplasia: A retrospective cohort study].

OBJECTIVE: To compare the effects of thulium laser enucleation of the prostate (ThuLEP) and monopolar transurethral resection of the prostate (TURP) on sexual function in patients with benign prostatic hyperplasia (BPH).

METHODS: A retrospective cohort study was conducted involving patients who underwent ThuLEP or TURP at the Department of Urology, Peking University First Hospital, between January 2022 and December 2023. Participants were recruited via convenience sampling. Propensity score matching (PSM) was subsequently employed to balance preoperative baseline characteristics between the two cohorts.Following propensity score matching, we conducted a comparative analysis of sexual function and voiding improvement metrics between the two cohorts. Sexual function was assessed using the international index of erectile function-5 (IIEF-5) scores and the incidence of retrograde ejaculation. Voiding outcomes were evaluated based on the international prostate symptom score (IPSS), qua-lity of life (QOL) scores.

RESULTS: Following propensity score matching, the study included 98 patients in both the ThuLEP and the TURP groups. Preoperative comparisons between the two groups regarding age, prostate volume, IIEF-5 scores, incidence of retrograde ejaculation, IPSS, and QOL showed no statistically significant differences (P>0.05), indicating comparability between the groups. Regarding erectile function, postoperative IIEF-5 scores at 1 month and 12 months in both the ThuLEP and TURP groups did not differ significantly from preoperative scores (P>0.05). At 1 month postoperatively, there was no significant difference in IIEF-5 scores between the ThuLEP and TURP groups (P>0.05). At the 12-month postoperative follow-up, the incidence of severe erectile dysfunction was significantly lower in the ThuLEP group compared with the TURP group (Z=8.522, P=0.036). Regarding ejaculatory function, the incidence of retrograde ejaculation at 1 month and 12 months postoperatively in both the ThuLEP and TURP groups differed significantly from preoperative rates (P < 0.05). Moreover, the incidence of retrograde ejaculation increased with time after surgery. At 1 month postoperatively, 9.2% of the ThuLEP group and 14.3% of the TURP group experienced retrograde ejaculation, which was not statistically different (Z=1.231, P=0.267). At 12 months postoperatively, the incidence of retrograde ejaculation in the ThuLEP and TURP groups was 19.4% and 25.5%, respectively, also showing no significant difference (Z=1.055, P=0.304). In terms of surgical parameters, comparisons of operative time, intraoperative blood loss, decrease in hemoglobin levels, and weight of resected prostate tissue between the ThuLEP and TURP groups revealed no significant differences (P>0.05). However, compared with the TURP group, the ThuLEP group had a shorter hospital stay (4 d vs. 5 d, P < 0.001) and shorter duration of indwelling urinary catheterization (3.67 d vs. 4.26 d, P=0.012), although bladder irrigation time was longer (19.00 h vs. 16.68 h, P=0.001). At 1 month and 12 months postoperatively, there were no significant differences between the two groups in IPSS, QOL metrics (P>0.05); how- ever, all these parameters showed significant improvement compared with preoperative values.

CONCLUSION: While both ThuLEP and TURP effectively alleviate lower urinary tract symptoms and improve voiding parameters, ThuLEP offers distinct advantages in safeguarding erectile potency and facilitating accelerated postoperative recovery.