Surgeon-led vs. nurse-led postoperative follow-up after dilep: impact on erectile function recovery and patient-reported outcomes.

PURPOSE: While 1470 nm Diode Laser Enucleation of the Prostate (DiLEP) effectively treats sexually active patients of benign prostatic hyperplasia, postoperative erectile function preservation remains a concern. This study compares the impact of surgeon-led (SLP) versus nurse-led (NLP) follow-up on erectile function recovery and patient-reported outcomes after DiLEP.

METHODS

In this propensity score-matched retrospective cohort study, we analyzed 126 patients undergoing DiLEP (2019-2023), equally divided into SLP and NLP groups. Primary outcomes included International Index of Erectile Function (IIEF) scores and patient-reported outcome measures (PROMs) at 3- and 6-month follow-ups. Secondary outcomes encompassed Lower urinary tract symptoms (LUTS), assessed using the International Prostate Symptom Score (IPSS), treatment satisfaction, evaluated via the Treatment Satisfaction Questionnaire (TS-Q) and psychological distress, measured by the Hospital Anxiety and Depression Scale (HADS).

RESULTS

The SLP group demonstrated superior erectile function recovery (6-month IIEF: 19.2 ± 2.96 vs. 17.7 ± 2.47, p = 0.003) and higher satisfaction rates (55.6% vs. 28.6%, p = 0.002). PROMs favored SLP at all timepoints (p < 0.05). Notably, SLP patients received earlier PDE5 inhibitor interventions (38.1% vs. 19.1%, p = 0.018), while both groups showed comparable IPSS improvement (p = 0.34). Anxiety scores (HADS-A) were lower in SLP patients (4.2 ± 1.8 vs. 5.1 ± 2.1, p = 0.03).

CONCLUSION

Surgeon-led follow-up significantly enhances erectile function recovery and patient satisfaction after DiLEP, potentially through earlier therapeutic interventions. These findings support integrating surgeon expertise into postoperative care pathways, particularly for sexually active patients prioritizing functional recovery.