Effects on Ejaculation Preservation Using Low-Energy Pulsed Thulium:YAG Laser Anatomical Enucleation in High-Volume Benign Prostatic Hyperplasia.

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.