In a review, researchers compared several surgical procedures used to improve erectile function (EF) in patients with lower urinary tract symptoms associated benign prostatic hyperplasia (LUTS/BPH), and suggested that some appear more effective than others.
The study, “The impact of surgical treatments for lower urinary tract symptoms/benign prostatic hyperplasia on male erectile function: A systematic review and network meta-analysis,” was published in Medicine (Baltimore).
A number of treatments for LUTS/BPH exist, including several oral therapies. However, about 30% of patients do not effectively respond to oral therapies and require surgical intervention. Some studies suggested that surgery can improve EF by relieving LUTS, but others found otherwise due to injury.
The researchers, at the Renmin Hospital of Wuhan University, in China, reviewed and analyzed a number of different surgical treatments utilized for LUTS/BPH and how such approaches impacted erectile function in patients. The review was essentially based on findings from randomized controlled trials, measuring EF through use of the International Index of Erectile Function-5 (IIEF-5).
The researchers first identified the appropriate trials and treatments given, then compared the outcome between studies.
A total of 18 clinical trials involving 2,433 participants were identified and analyzed, and nine surgical procedures were studied and compared: transurethral resection of the prostate (TURP), plasmakinetic resection of the prostate (PKRP), plasmakinetic enucleation of the prostate (PKEP), Holmium laser enucleation of the prostate (HoLEP), Holmium laser resection of the prostate (HoLRP), photoselective vaporization of the prostate (PVP), Thulium laser, open prostatectomy (OP), and laparoscopic simple prostatectomy (LSP).
Results indicated no negative effects (reduction in IIEF-5 scores) using most of the surgical approaches, except PVP. Some approaches showed benefits — increased postoperative EF — including HoLEP, PKEP, Thulium laser, and TURP.
When taken together, LSP was ranked on top of all procedures in terms of an improved IIEF-5 score, followed by PKRP, HoLEP, TURP, Thulium laser, PKEP, PVP, HoLRP, and OP. However, when the data were analyzed by subgroup (subgroups covering normal or deceased baseline IIEF-5 scores, and post-surgery time points), researchers found that PVP reduced postoperative EF only in the short term and in patients with decreased baseline EF, while TURP was seen to increase IIEF-5 scores only in patients with normal baseline EF.
HoLEP and PKEP were found in this analysis to improve EF scores in all patients, even in those with reduced baseline erectile function and on short-term follow-up.
Limitations in the clinical trials reviewed in this study, and possibly poor baseline EF data, however, may have affected the outcomes, the researchers said.
“Our novel data demonstrating surgical treatments for LUTS/BPH showed no negative impact on postoperative EF except PVP,” they wrote, adding that because of possible limitations, “further studies and longer follow-up are required to substantiate our findings.”
BPH is characterized by increased prostate size in men and usually associated with lower urinary tract symptoms and reduced sexual function.