Ejaculation-preserving technique in transurethral plasmakinetic enucleation of the prostate

doi:10.3877/cma.j.issn.1674-3253.2024.02.006

Abstract

Abstract:

Objective

To explore the effectiveness of ejaculation-preserving technique to transurethral plasmakinetic enucleation of the prostate (PKEP).

Methods

A total of 106 patients with suffificient ejaculate of BPH underwent PKEP from June 2015 to September 2022 in Qianhai Shekou Free Trade Zone Hospital and the Second Hospital Affiliated to Kunming Medical University, paracollicular and supracollicular tissue nearly 1cm proximal to the verumontanum was preserved. Operative time, bladder irrigation time, catheter indwelling time, postoperative hospital stay time and peri-operative complications were recorded. International prostatic symptom score (IPSS), quality of life (QOL) score, postvoid residual urine vo1ume (PVR), International Index of Erectile Function 5 (IIEF-5), maximum flow rate (Q_max) were measured preoperatively, 1 and 6 months postoperatively, rate of ejaculation preservation were also recorded.

Results

All of the 106 cases were operated successfully and none of them converted to open surgery. The mean operating time, bladder irrigation time, catheter indwelling time and postoperative hospital stay were (66±12) min, (29.3±2.8) h, (3.8±0.7) d, (4.1±1.2) d, respectively. C1inical outcomes(IPSS, QOL score, Q_max and PVR) showed significantly improvement from baseline (P<0.001), there were no significant changes in IIEF-5 (P>0.05). Ejaculation volume was unchanged, decreased or vanished in 89(83.96%), 6(5.66%) and 11(10.38%) case, respectively. No severe complications were observed.

Conclusion

Ejaculation-preserving technique in PKEP can not only relieve the clinical symptoms of BPH patients, but also effectively reduce the proportion of retrograde ejaculation after surgery, which is worthy of popularization and application.

Key words: Benign prostatic hyperplasia, Enucleation of prostate, Ejaculation-preserving, Retrograde ejaculation

Yang Wang, Zhipeng Li, Nan Zhang, Haitian He, Weifeng Yang, Huanling Zhang, Kebing Wang. Ejaculation-preserving technique in transurethral plasmakinetic enucleation of the prostate[J]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(02): 152-156.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhqjmnmwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3253.2024.02.006

https://zhqjmnmwkzz.cma-cmc.com.cn/EN/Y2024/V18/I02/152

Figures/Tables 3

References 26

[1]	Liao J, Zhang X, Chen M, et al. Transurethral resection of the prostate with preservation of the bladder neck decreases postoperative retrograde ejaculation[J]. Wideochir Inne Tech Maloinwazyjne, 2019, 14(1): 96-101.
[2]	Huet R, Peyronnet B, Khene ZE, et al. Prospective assessment of the sexual function after greenlight endoscopic enucleation and greenlight 180W XPS photoselective vaporization of the prostate[J]. Urology, 2019, 131: 184-189.
[3]	De Nunzio C, Tabatabaei S, Tubaro A. Ejaculation disorders in prostate surgery[J]. Minerva Urol Nefrol, 2019, 71(5): 549-550.
[4]	Bouhadana D, Nguyen DD, Zorn KC, et al. Patient perspectives on benign prostatic hyperplasia surgery: a focus on sexual health[J]. J Sex Med, 2020, 17(10): 2108-2112.
[5]	Calik G, Laguna MP, Gravas S, et al. Preservation of antegrade ejaculation after surgical relief of benign prostatic obstruction is a valid endpoint[J]. World J Urol, 2021, 39(7): 2277-2289.
[6]	Kim JK, Cho MC, Son H, et al. Patient perception of ejaculatory volume reduction after holmium laser enucleation of the prostate (HoLEP)[J]. Urology, 2017, 99: 142-147.
[7]	Elshal AM, El-Assmy A, Mekkawy R, et al. Prospective controlled assessment of men's sexual function changes following Holmium laser enucleation of the prostate for treatment of benign prostate hyperplasia[J]. Int Urol Nephrol, 2017, 49(10): 1741-1749.
[8]	Kim M, Song SH, Ku JH, et al. Pilot study of the clinical efficacy of ejaculatory hood sparing technique for ejaculation preservation in Holmium laser enucleation of the prostate[J]. Int J Impot Res, 2015, 27(1): 20-24.
[9]	Gosling JA, Thompson SA. A neurohistochemical and histological study of peripheral autonomic neurons of the human bladder neck and prostate[J]. Urol Int, 1977, 32(4): 269-276.
[10]	Gil-Vernet JM Jr, Alvarez-Vijande R, Gil-Vernet A, et al. Ejaculation in men: a dynamic endorectal ultrasonographical study[J]. Br J Urol, 1994, 73(4): 442-448.
[11]	Dorschner W, Stolzenburg JU. A new theory of micturition and urinary continence based on histomorphological studies. 5. The musculus ejaculatorius: a newly described structure responsible for seminal emission and ejaculation[J]. Urol Int, 1994, 53(1): 34-37.
[12]	Press B, Gardezi M, Kim DD, et al. Ejaculatory preserving holmium laser enucleation of the median lobe: preserving sexual function while improving urinary outcomes[J]. Urology, 2023, 173(12): 175-179.
[13]	Kini M, Te AE, Kashanian JA, et al. Ejaculatory hood-sparing photoselective vaporization of the prostate vs bipolar button plasma vaporization of the prostate in the surgical management of benign prostatic hyperplasia[J]. J Endourol, 2020, 34(3): 322-329.
[14]	Brant A, Cho A, Calderon LP, et al. Ejaculatory hood-sparing vaporization of the prostate and its impact on erectile, ejaculatory, and sexual function[J]. Urology, 2020, 144: 177-181.
[15]	Trama F, Lauro GD, Illiano E, et al. Ejaculation sparing thulium laser enucleation of the prostate: an observational prospective study[J]. J Clin Med, 2022, 11(21): 6365.
[16]	Contreras P, Bonanno N, Rios Pita H, et al. Antegrade ejaculation preservation technique with GreenLight XPS 180-W: functional ejaculatory results[J]. J Endourol, 2021, 35(3): 349-352.
[17]	Bozzini G, Berti L, Maltagliati M, et al. Ejaculation-sparing thulium laser enucleation of the prostate (ES-ThuLEP): outcomes on a large cohort[J]. World J Urol, 2021, 39(6): 2029-2035.
[18]	Elshazly M, Sultan S, Shaban M, et al. Evaluation of a novel technique of bladder neck and supramontanal sparing ejaculatory preserving transurethral prostatectomy[J]. World J Urol, 2021, 39(11): 4215-4219.
[19]	Porreca A, Mineo Bianchi F, D'Agostino D, et al. Ejaculation sparing bladder neck incision with holmium laser in patients with urinary symptoms and small prostates: short-term functional results[J]. Urol Int, 2019, 103(1): 102-107.
[20]	Guldibi F, Altunhan A, Aydın A, et al. What is the effect of laser anatomical endoscopic enucleation of the prostate on the ejaculatory functions? A systematic review[J].World J Urol, 2023, 41(12): 3493-3501.
[21]	Couteau N, Duquesne I, Frédéric P, et al. Ejaculations and benign prostatic hyperplasia: an impossible compromise? A comprehensive review[J]. J Clin Med, 2021, 10(24): 5788.
[22]	汪洋, 韩庆平, 和术臣, 等. 前列腺剜除术中保留精阜近端组织对减少低龄患者术后逆行射精的疗效研究[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2018, 12(5): 327-331.
[23]	Malalasekera AP, Sivasuganthan K, Sarangan S, et al. Morphological variations of the human ejaculatory ducts in relation to the prostatic urethra[J]. Clin Anat, 2018, 31(4): 456-461.
[24]	Migliari R, Mele F, Barale M, et al. An innovative technique for ejaculation-sparing prostatic enucleation with thulium:YAG Laser[J].J Endourol, 2023, 37(12): 1282-1288.
[25]	Talab SS, Santiago-Lastra YA, Bachmann A, et al. v403 the impact of ejaculation-preserving photo-selective vaporization of the prostate (ep-pvp) on lower urinary tract symptoms and ejaculatory function: results of a multicenter study[J]. J Urol, 2013, 189(4): e164-e164.
[26]	Lebdai S, Ben Boujema M, Benard A, et al. Standardized technique for ejaculation preservation during prostatic endoscopic ablative surgery[J]. World J Urol, 2023, 41(11): 3041-3049.

组别	Q_max(ml/s)	PVR(ml)	IPSS评分(分)	QOL评分(分)	IIEF-5(分)
术前	8.7±1.8	108±26	20.8±5.6	4.5±1.1	16.7±3.0
术后1个月	19.3±1.6^a	15±7^a	6.4±2.4^a	1.6±0.9^a	16.4±3.0^A
术后6个月	19.4±1.3^a	14±6^a	6.0±2.2^a	1.4±0.8^a	16.8±2.7^A

组别	Q_max(ml/s)	PVR(ml)	IPSS评分(分)	QOL评分(分)	IIEF-5(分)
术前	8.7±1.8	108±26	20.8±5.6	4.5±1.1	16.7±3.0
术后1个月	19.3±1.6^a	15±7^a	6.4±2.4^a	1.6±0.9^a	16.4±3.0^A
术后6个月	19.4±1.3^a	14±6^a	6.0±2.2^a	1.4±0.8^a	16.8±2.7^A

组别	顺行射精	不完全逆行射精	完全逆行射精
术前	106（100）	0	0
术后6个月	89（83.96）	6（5.66）	11（10.38）

组别	顺行射精	不完全逆行射精	完全逆行射精
术前	106（100）	0	0
术后6个月	89（83.96）	6（5.66）	11（10.38）

Please choose a citation manager

Content to export