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

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Abstract

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.

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Author information

Author notes

  1. Souhil Lebdai and Armand Chevrot are first co-authors.

Authors and Affiliations

  1. Urology Department, University Hospital of Angers, CHU Angers, 4 rue Larrey, 49933, Angers Cedex 9, France

    Souhil Lebdai

  2. Urology Department, University Hospital of Nimes, 30900, Nîmes, France

    Armand Chevrot

  3. Urology Department, Hôpital Européen Georges Pompidou, Paris, France

    Steeve Doizi

  4. Urology Department, University Hospital of Tours, Tours, France

    Benjamin Pradere

  5. Urology Department, University Hospital of Cochin, 75014, Paris, France

    Nicolas Barry Delongchamps

  6. Urology Department, Clinique les Martinets, Versailles, France

    Amine Benchikh

  7. Urology Department, University Hospital of Rouen, Rouen, France

    Jean Nicolas Cornu

  8. Urology Department, Hôpital des Côtes d’Armor, Saint Brieuc, France

    Emmanuel Della Negra

  9. Urology Department, Hospital of Aix en Provence, 13001, Aix en Provence, France

    Marc Fourmarier

  10. Urology Department, Clinique Pasteur, Toulouse, France

    Vincent Misraï

  11. Urology Department, Saint Joseph Hospital, Paris, France

    Pierre Etienne Theveniaud

  12. Urology Department, University Hospital of Limoges, Limoges, France

    Aurélien Descazeaud

  13. Urology Department, University Hospital of Bordeaux, Bordeaux, France

    Grégoire Robert

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  1. Souhil Lebdai
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For the CTMH-AFU group

Contributions

SL: project development, data collection, and manuscript writing. AC: project development, data collection, and manuscript writing. NBD, AB, JNC, AD, SD, MF, BP, VM, GR, and PET: project development and reviewing.

Corresponding author

Correspondence to Souhil Lebdai.

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Conflict of interest

Armand Chevrot: none. Nicolas Barry Delongchamps: none. Amin Benchikh: none. Jean Nicolas Cornu: none. Aurélien Descazeaud: consultant for Bouchara Recordati, Pierre Fabre Medicament, Lilly, investigator pour EDAP TMS. Steeve Doizi: none. Marc Fourmarier: consultant for GSK and EDAP TMS. Souhil Lebdai: none. Benjamin Pradère: none. Vincent Misraï: none. Gregoire Robert: consultant for Pierre Fabre Medicament, investigator for EDAP TMS. Pierre Etienne Theveniaud: none.

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Lebdai, S., Chevrot, A., Doizi, S. et al. Do patients have to choose between ejaculation and miction? A systematic review about ejaculation preservation technics for benign prostatic obstruction surgical treatment. World J Urol 37, 299–308 (2019). https://doi.org/10.1007/s00345-018-2368-6

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