Do patients have to choose between ejaculation and miction? A systematic review about ejaculation preservation technics for benign prostatic obstruction surgical treatment

Souhil Lebdai ¹,
Armand Chevrot ²,
Steeve Doizi ³,
Benjamin Pradere ⁴,
Nicolas Barry Delongchamps ⁵,
Amine Benchikh ⁶,
Jean Nicolas Cornu ⁷,
Emmanuel Della Negra ⁸,
Marc Fourmarier ⁹,
Vincent Misraï ¹⁰,
Pierre Etienne Theveniaud ¹¹,
Aurélien Descazeaud ¹²,
Grégoire Robert ¹³

¹ Urology Department, University Hospital of Angers, CHU Angers, Angers Cedex, France ² Urology Department, University Hospital of Nimes, Nîmes, France ³ Urology Department, Hôpital Européen Georges Pompidou, Paris, France ⁴ Urology Department, University Hospital of Tours, Tours, France ⁵ Urology Department, University Hospital of Cochin, Paris, France ⁶ Urology Department, Clinique les Martinets, Versailles, France ⁷ Urology Department, University Hospital of Rouen, Rouen, France ⁸ Urology Department, Hôpital des Côtes d’Armor, Saint Brieuc, France ⁹ Urology Department, Hospital of Aix en Provence, Aix en Provence, France ¹⁰ Urology Department, Clinique Pasteur, Toulouse, France ¹¹ Urology Department, Saint Joseph Hospital, Paris, France ¹² Urology Department, University Hospital of Limoges, Limoges, France ¹³ Urology Department, University Hospital of Bordeaux, Bordeaux, France

Abstract

https://link.springer.com/article/10.1007/s00345-018-2368-6

Purpose

Ejaculatory dysfunction is the most common side effect related to surgical treatment of benign prostatic obstruction (BPO). Nowadays, modified surgical techniques and non-ablative techniques have emerged with the aim of preserving antegrade ejaculation. Our objective was to conduce a systematic review of the literature regarding efficacy on ejaculatory preservation of modified endoscopic surgical techniques, and mini-invasive non-ablatives techniques for BPO management.

Methods
A systematic review of the literature was carried out on the PubMed database using the following MESH terms: “Prostatic Hyperplasia/surgery” and “Ejaculation”, in combination with the following keywords: “ejaculation preservation”, “photoselective vaporization of the prostate”, “photoselective vapo-enucleation of the prostate”, “holmium laser enucleation of the prostate”, “thulium laser”, “prostatic artery embolization”, “urolift”, “rezum”, and “aquablation”.

Results
The ejaculation preservation rate of modified-TURP ranged from 66 to 91%. The ejaculation preservation rate of modified-prostate photo-vaporization ranged from 87 to 96%. The only high level of evidence studies available compared prostatic urethral lift (PUL) and aquablation versus regular TURP in prospective randomized-controlled trials. The ejaculation preservation rate of either PUL or aquablation compared to regular TURP was 100 and 90 versus 34%, respectively.

Conclusions
Non-ablative therapies and modified endoscopic surgical techniques seemed to be reasonable options for patients eager to preserve their ejaculatory functions.