Abstract
Purpose
Transurethral resection of the prostate (TURP) can achieve highly satisfying symptomatic and functional outcomes but the loss of antegrade ejaculation represents a major reason for the avoidance of surgical treatment to preserve normal ejaculation and paternity. We present a novel technique to duplicate both bladder neck sparing and supramontanal sparing with resection of apical tissues to improve voiding and antegrade ejaculation.
Methods
A prospective study done from June 2018 to June 2020 on 60 consecutive male patients with normal sexual activity diagnosed with benign prostatic enlargement. These patients were randomized into two groups; 30 patients in each group. Group 1 underwent bladder neck and supramontanal sparing ejaculatory preserving transurethral bipolar resection of prostate (ep-TUBRP) and Group 2 underwent classic transurethral bipolar resection of prostate (c-TUBRP). All patients were evaluated pre- and postoperatively (after 3 months) using IPSS, Qmax and by IIEF-5.
Results
In both groups, there were significant improvements 3 months postoperative in Qmax [7.97 mL/s to 18.47 mL/s (group A) and 7.8 to 20.7 mL/s (group B)] and in micturition symptoms according to reductions in IPSS score [24 to 7.5 (group A) and 25 to 8.5 (group B)]. IIEF-5 score improved significantly from a mean of 12.9 to 18.6 (group A) and from 11.6 to 16.4 (group B). Antegrade ejaculation reported in 80% of patients in group A and 27% in group B which was significant (p < 0.001). Postoperative period did not reveal acute urinary retention, stress urinary incontinence, or serious adverse events.
Conclusions
On short-term results, bladder neck and supramontanal ejaculation preserving transurethral bipolar resection of the prostate is superior to classic TURP in preservation of forward ejaculation with comparable efficacy in micturition parameters.
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Abbreviations
- BOO:
-
Bladder outlet obstructions
- BPO:
-
Benign prostate obstruction
- BPH:
-
Benign prostatic hyperplasia
- c-TUBRP:
-
Classic transurethral bipolar resection of prostate
- ep-TUBRP:
-
Ejaculation-preserving transurethral bipolar resection of prostate
- IIEF-5:
-
International Index of Erectile Function-5
- IPSS:
-
International Prostate Symptoms Score
- HoLEP:
-
Holmium laser enucleation of the prostate
- Qmax:
-
Maximum flow rate
- ThuLEP:
-
Thulium laser enucleation of the prostate
- TURP:
-
Transurethral resection of prostate
- TUIP:
-
Transurethral incision of the prostate
References
Roehrborn CG et al (2007) The benign prostatic hyperplasia registry and patient survey: study design, methods and patient baseline characteristics. BJU Int 100(4):813–819
Reich O et al (2008) Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol 180(1):246–249
Terrone C et al (2001) Iatrogenic ejaculation disorders and their prevention. Minerva Urol Nefrol 53(1):19–28
Gil-Vernet JM Jr et al (1994) Ejaculation in men: a dynamic endorectal ultrasonographical study. Br J Urol 73(4):442–448
Alloussi SH et al (2014) Ejaculation-preserving transurethral resection of prostate and bladder neck: short- and long-term results of a new innovative resection technique. J Endourol. 28(1):84–89
Dornbier R, Guidelines TNAUABPHC et al (2019) Update. Curr Urol Rep 21(9):32
Teo JS, Lee YM, Ho HSS (2017) An update on transurethral surgery for benign prostatic obstruction. Asian J Urol. 4(3):195–198
Liao J et al (2019) Transurethral resection of the prostate with preservation of the bladder neck decreases postoperative retrograde ejaculation. Wideochir Inne Tech Maloinwazyjne. 14(1):96–101
Lourenco T et al (2009) The clinical effectiveness of transurethral incision of the prostate: a systematic review of randomised controlled trials. World J Urol 28(1):23–32
Webster GD, Lockhart JL, Older RA (1980) The evaluation of bladder neck dysfunction. J Urol 123(2):196–198
Kaplan SA, Te AE, Jacobs BZ (1994) Urodynamic evidence of vesical neck obstruction in men with misdiagnosed chronic nonbacterial prostatitis and the therapeutic role of endoscopic incision of the bladder neck. J Urol 152(6 Pt 1):2063–2065
Hermabessiere J, Guy L, Boiteux JP (1999) Human ejaculation: physiology, surgical conservation of ejaculation. Prog Urol 9(2):305–309
Ronzoni G, De Vecchis M (1998) Preservation of anterograde ejaculation after transurethral resection of both the prostate and bladder neck. Br J Urol 81(6):830–833
Malalasekera AP et al (2018) Morphological variations of the human ejaculatory ducts in relation to the prostatic urethra. Clin Anat 31(4):456–461
Gul Z et al (2019) Ejaculatory preserving middle lobe onl-transurethral resection and vaporization of the prostate: 12-year experience. Urology 134:199–202
Rassweiler J et al (2006) Complications of transurethral resection of the prostate (TURP)–incidence, management, and prevention. Eur Urol 50(5):969–979
Xia SJ et al (2008) Thulium laser versus standard transurethral resection of the prostate: a randomized prospective trial. Eur Urol 53(2):382–389
Leonardi R (2009) Preliminary results on selective light vaporization with the side-firing 980 nm diode laser in benign prostatic hyperplasia: an ejaculation sparing technique. Prostate Cancer Prostatic Dis 12(3):277–280
Kim M et al (2014) Pilot study of the clinical efficacy of ejaculatory hood sparing technique for ejaculation preservation in Holmium laser enucleation of the prostate. Int J Impot Res 27(1):20–24
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M. Elshazly: Surgical procedure. S. Sultan: Protocol development. M. Shaban: Data Collection. F. Zanaty: Manuscript writing and data analysis.
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The study was approved by Menoufia university—Faculty of medicine ethics committee. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
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The study protocol was approved by our local ethical committee. All participants signed written informed consent before inclusion in the study.
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Elshazly, M., Sultan, S., Shaban, M. et al. Evaluation of a novel technique of bladder neck and supramontanal sparing ejaculatory preserving transurethral prostatectomy. World J Urol 39, 4215–4219 (2021). https://doi.org/10.1007/s00345-021-03752-z
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DOI: https://doi.org/10.1007/s00345-021-03752-z