Influence of photoselective vaporization of the prostate on sexual function: results of a prospective analysis of 149 patients with long-term follow-up

Abstract

Background: Even though transurethral resection of the prostate remains the gold standard treatment for lower urinary tract symptoms (LUTS) refractory to medical therapy, photoselective vaporization of the prostate (PVP) has become a popular alternative. Early PVP studies seem encouraging, but few data exist regarding the effect of PVP on sexual function at long-term follow-up.

Objective: Our aim was to evaluate the impact of PVP on erectile function (EF) at long-term follow-up in men with LUTS due to benign prostatic hyperplasia (BPH).

Design, setting, and participants: One hundred forty-nine consecutive patients who underwent a prostate vaporization with the GreenLight laser performed by a single surgeon (FB) were prospectively enrolled in this study.

Intervention: All patients underwent PVP with the GreenLight laser performed by one experienced surgeon.

Measurements: All patients were evaluated by International Index of Erectile Function (IIEF-5) preoperatively and at 1, 3, 6, and 12 mo and then once a year. At each visit, the questionnaires were collected, and each patient's maximum flow rate and postvoid residual volume were measured with ultrasound. Biologic data were also collected at each visit, including prostate-specific antigen, creatinine, and bacterial urine culture.

Results and limitations: One hundred forty-nine patients were enrolled in the study. Median patient age was 74 yr. Urinary function was significantly improved over baseline in both men with normal or abnormal preoperative erectile function. Energy used was 255+/-129kJ. Hospitalization stay was 2.2+/-3.1 d. Other than a temporary difference at 1 yr, IIEF-5 scores were comparable preoperatively and postoperatively if we consider all the population. However, considering patients with preoperative IIEF-5 >19, the postoperative IIEF-5 scores were significantly decreased at 6, 12, and 24 mo.

Conclusions: Sexual function appears to be maintained after PVP; however, in patients with normal preoperative EF, we showed a significant decrease in EF after PVP.