2014 INCIDENCE OF ERECTILE DYSFUNCTION AND RETROGRADE EJACULATION FOLLOWING THULIUM LASER VAPORESECTION OF THE PROSTATE FOR BENIGN BLADDER OUTFLOW OBSTRUCTION

Vol. 187, No. 4S, Supplement, Wednesday, May 23, 2012

2013 EJACULATION PRESERVING TRANS URETHRAL RESECTION OF PROSTATE: A PILOT STUDY Srinath Chandrasekera*, Nugegoda, Sri Lanka; Surendra De Zylva, Nilanganie Lamahewage, Colombo, Sri Lanka; Maheesha Kulasinghe, Nugegoda, Sri Lanka INTRODUCTION AND OBJECTIVES: Despite numerous advances seen in surgery for BPH, retrograde ejaculation remains as the commonest and unconquered morbidity. Given an option most sexually active men undergoing TURP are likely to prefer to have their ejaculation preserved. The objective of this study was to assess the safety and feasibility of our technique of “Ejaculation Preserving TURP” and evaluate short term outcomes. Our study was based on the hypothesis that occluding supra montal prostatic adenoma plays a role in maintaining antegrade ejaculation in men with prostatic obstruction. METHODS: We assessed fifteen sexually active males aged 51 to 66 (mean-58.5 years) undergoing Ejaculation Preserving TURP. Mean prostatic volume was 37.6ml (range 12-59ml). Nine were due to failed medical therapy and 6 were in refractory urinary retention. Bipolar TURP was done resecting adenoma at bladder neck including median lobe when present and prostatic urethra. Two small cushions of adenoma and prostatic mucosa were preserved at the prostatic apex and a few millimeters of prostatic urethral mucosa just above the veru montanum. Care was taken not to create “flap valves”. We used a scoring system to assess the degree of projection of the ejaculate “Ejaculation Projection Score”. ie:0⫽no ejaculation, 1⫽few drops only, 2⫽non projectile, 3⫽projectile, 4⫽strongly projectile. Patients were assessed pre operatively, at 6 weeks, 3 months, 6 months and 12 months. RESULTS: At one year their mean maximum flow rates improved from 6.3ml/S to 22ml/S (p⫽0.000),residual urine volumes from 120ml to 34ml (p⫽0.000),IPSS scores from 25 to 5.8 (p⫽0.000) and quality of life scores from 5.2 to 1.2 (p⫽0.000). Strikingly, the ejaculatory function remained unchanged (IIEF question 9) from 4 to 3.5 (p⫽0.02) and “ejaculation projection score” from 3.3 to 3.1 (p⫽0.57).IIEF score remained unchanged from 54 to 56.4 (p⫽0.29). 12 /15 had no change or improved ejaculation following surgery and cessation of medical therapy denoting a success rate of 80%.1/15 had complete loss of ejaculation while 2/15 had reduced ejaculation. There were no major morbidities or mortality. CONCLUSIONS: Ejaculation Preserving TURP is a safe and feasible option with promising initial results. Our success with various sized adnomata even in those with urinary retention implies the satisfactory degree of unblocking of the outflow with this technique whist preserving antegrade ejaculation. Results of this study further confirms the role of the supra montal prostatic adenoma in maintaining antegrade ejaculation in those with obstructing BPH. Source of Funding: None

2014 INCIDENCE OF ERECTILE DYSFUNCTION AND RETROGRADE EJACULATION FOLLOWING THULIUM LASER VAPORESECTION OF THE PROSTATE FOR BENIGN BLADDER OUTFLOW OBSTRUCTION Raj Pal*, Carol Ling, Sze Yee, Andrew Batchelder, Masood Khan, Leicester, United Kingdom INTRODUCTION AND OBJECTIVES: Endoscopic procedures utilising modern laser technology to treat BPH have become increasingly common. Several studies have demonstrated feasibility and efficacy of Tm:YAG vaporessection (ThuVaRP) in improving urinary symptoms. However, reports on sexual dysfunction following ThuVaRP are sparse. The aim of this study was to determine the incidence of erectile dysfunction and retrograde ejaculation following ThuVaRP. METHODS: 113 patients underwent ThuVaRP for bladder outflow obstruction between January 2009 to June 2010 at out institute. Only patients who were able to sustain an erection for the duration of

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sexual intercourse were included in this study. All patients had benign pathology. The incidence of erectile dysfunction and retrograde ejaculation was reported at 12 months post-operatively. We further evaluated the effect of cardiovascular disease risk factors, pre-operative catheterisation and resection weight on post-operative sexual dysfunction. RESULTS: 54/113 patients (48%) were included in the study as they were sexually active prior to undergoing ThuVaRP. The mean patient age was 71 years (range:46-90) and the mean follow-up period was 12 months (range: 4-21). 11/54 (20%) patients experienced worsening erectile function following surgery compared to pre-operatively. 43/54 (80%) noticed no change or an improvement in erectile function. Retrograde ejaculation occurred in 30/54 (56%) patients. The remainder of patients noticed no change or an improvement in their ejaculate. Pre-operative catheterisation and diabetes mellitus was associated with an increased likelihood of post-operative retrograde ejaculation (P⫽0.04 and P⫽0.03 respectively). There was an increased trend of erectile dysfunction in men aged over 70 years, with hypertension and hypercholesterlaemia but this was not significant. CONCLUSIONS: Our retrospective study has demonstrated that the overall risk of erectile dysfunction and retrograde ejaculation associated with ThuVaRP is 20% and 56% respectively. Source of Funding: None

2015 CHANGES IN ERECTILE FUNCTION AFTER PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE FOR BENIGN PROSTATIC HYPERPLASIA Piotr Zareba*, Alym Abdulla, Jim Bowen, Rob Hopkins, Jean-Eric Tarride, John Paul Whelan, Hamilton, Canada INTRODUCTION AND OBJECTIVES: Although photoselective vaporization of the prostate (PVP) has been shown to significantly improve voiding function in men with benign prostatic hyperplasia (BPH), its effect on erectile function is unknown. The purpose of this study was to characterize changes in erectile function in a large cohort of men undergoing PVP. METHODS: The present analysis was conducted on the PVP arm of a non-randomized clinical trial comparing PVP and transurethral resection of the prostate (TURP). All procedures were performed by a single surgeon using a 120 W GreenLight HPS laser. Subjects completed the Sexual Healthy Inventory for Men (SHIM) and International Prostate Symptom Score (IPSS) questionnaires prior to surgery and at six months postoperatively. All data were collected prospectively and there was no loss to follow-up. Associations between change in SHIM score and other clinical variables were tested using the Spearman rank correlation coefficient for continuous variables and the Wilcoxon-MannWhitney or Kruskal-Wallis tests for categorical variables. All tests of association were two-sided and performed at a level of significance of 0.05. RESULTS: A total of 140 men with a mean age of 67.4 (range 47.8-85.2) years were included in the analysis. Preoperatively, 20 patients (14.3%) had no ED (SHIMⱖ22), 30 (21.4%) had mild ED (SHIM⫽17-21), 26 (18.6%) had mild to moderate ED (SHIM⫽12-16), 18 (12.9%) had moderate ED (SHIM⫽8-11), and 46 (32.9%) had severe ED (SHIM⫽1-7). Preoperative SHIM score was negatively correlated with age (Spearman’s r⫽⫺0.33, p⬍0.001) but not preoperative IPSS or any other clinical variables. Mean SHIM score decreased by 0.9 points after PVP. However, wide variation was seen, with 54 patients (38.6%) showing an increase, 23 (16.4%) showing no change, and 63 (45.0%) showing a decrease in SHIM score after PVP. The only significant predictor of change in SHIM score was change in IPSS (Spearman’s r⫽⫺0.18, p⫽0.03), with men experiencing a greater improvement in voiding symptoms also reporting better postoperative erectile function. There was no significant correlation between change in SHIM score and age (p⫽0.62), duration of voiding symptoms (p⫽0.31), preoperative BPH medical therapy (p⫽0.96), PDE5-inhibitor therapy (p⫽0.80), or total energy used (p⫽0.55).