Journal of endourology · 2025
Effects on Ejaculation Preservation Using Low-Energy Pulsed Thulium:YAG Laser Anatomical Enucleation in High-Volume Benign Prostatic Hyperplasia.
СтатьяКлиническое исследованиеНазвание и аннотация: Перевод в очереди
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Giacobbe Alessandro, Mele Fabrizio, Barale Maurizio, Giordano Andrea, Migliari Marco, Pini Federica, Migliari Roberto
Аннотация
PURPOSE: This study investigates the efficacy of an innovative anatomical enucleation prostate technique, utilizing a low-energy pulsed thulium:YAG laser emission, to spare the ventral urethral plate (or "lissosphincter") and the ejaculatory hoods in 50 patients with high-volume benign prostatic hyperplasia (BPH). The primary aim was to assess its impact on preserving antegrade ejaculation while obtaining relief from obstruction.
MATERIALS AND METHODS: In this prospective study, 50 patients were evaluated using the following validated instruments: the International Prostate Symptom Index (IPSS), Quality of Life (QoL) score, and Male Sexual Health Questionnaire Ejaculatory Dysfunction Short Form (MSHQ-EjD SF). Assessments were performed preoperatively and at 6 months postoperation.
RESULTS: Significant improvements were observed postoperatively in functional outcomes: IPSS decreased from 20.42 to 5.76, and QoL score improved from 4.2 to 1.2 (both p < 0.001, if significant). Mean Qmax significantly increased from 8.11 mL/min preoperatively to 20.6 mL/min at 6 months (p < 0.001), accompanied by a significant reduction in postvoid residual (PVR) volume. Crucially, antegrade ejaculation was preserved. While MSHQ-EjD SF analysis indicated a nonsignificant reduction in semen volume (Item 3), other parameters, including ejaculation frequency (Item 1), strength of expulsion (Item 2), and bother/satisfaction (Item 4), were not significantly modified, but the patients were satisfied.
CONCLUSION: The ejaculation-sparing pulsed thulium:YAG laser anatomical enucleation technique shows promising results for preserving antegrade ejaculatory function (70% preservation rate) while achieving effective relief of cervico-prostatic obstruction. However, these preliminary findings from a limited cohort require validation through larger, randomized controlled studies with longer follow-up before establishing this technique as a standard approach for ejaculation preservation in BPH operations.
MATERIALS AND METHODS: In this prospective study, 50 patients were evaluated using the following validated instruments: the International Prostate Symptom Index (IPSS), Quality of Life (QoL) score, and Male Sexual Health Questionnaire Ejaculatory Dysfunction Short Form (MSHQ-EjD SF). Assessments were performed preoperatively and at 6 months postoperation.
RESULTS: Significant improvements were observed postoperatively in functional outcomes: IPSS decreased from 20.42 to 5.76, and QoL score improved from 4.2 to 1.2 (both p < 0.001, if significant). Mean Qmax significantly increased from 8.11 mL/min preoperatively to 20.6 mL/min at 6 months (p < 0.001), accompanied by a significant reduction in postvoid residual (PVR) volume. Crucially, antegrade ejaculation was preserved. While MSHQ-EjD SF analysis indicated a nonsignificant reduction in semen volume (Item 3), other parameters, including ejaculation frequency (Item 1), strength of expulsion (Item 2), and bother/satisfaction (Item 4), were not significantly modified, but the patients were satisfied.
CONCLUSION: The ejaculation-sparing pulsed thulium:YAG laser anatomical enucleation technique shows promising results for preserving antegrade ejaculatory function (70% preservation rate) while achieving effective relief of cervico-prostatic obstruction. However, these preliminary findings from a limited cohort require validation through larger, randomized controlled studies with longer follow-up before establishing this technique as a standard approach for ejaculation preservation in BPH operations.