Skip to main content

Advertisement

Log in

Contemporary Review of BPH Medical and Surgical Treatments on Sexual Function

  • Male Sexual Dysfunction and Disorders (A Pastuszak and N Gupta, Section Editors)
  • Published:
Current Sexual Health Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Contemporary urologists have myriad options to offer patients when discussing treatments for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). While the primary goal of managing BPH is to improve LUTS, many treatments cause adverse effects on sexual function including erectile and ejaculatory function and libido. In the past 5 years, new literature has continued to evaluate the impact that medical, minimally invasive, and surgical BPH therapies have on sexual function.

Recent Findings

Research on medical treatment continues to show high rates of erectile and ejaculatory dysfunction in addition to low libido. Minimally invasive procedures had the lowest risk of developing both ejaculatory and erectile dysfunction. Invasive procedures such as transurethral resection of the prostate (TURP) caused significant ejaculatory dysfunction, while holmium laser enucleation of the prostate (HoLEP) caused significant erectile dysfunction.

Summary

Not all existing studies are comprehensive in their analysis of sexual function with impacts on libido being the least reported. Sexual function remains at a high level of patient concern and can be a significant source of procedural dissatisfaction. Appropriate preoperative counseling and further comparison studies are of paramount importance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major Importance

  1. Amerson D, editor. Urolift for BPH: changing the game in BPH care. AACU state advocacy conference; 2015; Chicago, IL.

  2. Taub DA, Wei JT. The economics of benign prostatic hyperplasia and lower urinary tract symptoms in the United States. Curr Urol Rep. 2006;7(4):272–81.

    Article  Google Scholar 

  3. Saigal CS, Joyce G. Economic costs of benign prostatic hyperplasia in the private sector. J Urol. 2005;173(4):1309–13. https://doi.org/10.1097/01.ju.0000152318.79184.6f.

    Article  PubMed  Google Scholar 

  4. Rosen R, Altwein J, Boyle P, Kirby RS, Lukacs B, Meuleman E, et al. Lower urinary tract symptoms and male sexual dysfunction: the multinational survey of the aging male (MSAM-7). Eur Urol. 2003;44(6):637–49.

    Article  Google Scholar 

  5. McVary KT, Roehrborn CG, Avins AL, Barry MJ, Bruskewitz RC, Donnell RF, et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol. 2011;185(5):1793–803. https://doi.org/10.1016/j.juro.2011.01.074.

    Article  PubMed  Google Scholar 

  6. AUA guideline on management of benign prostatic hyperplasia. Chapter 1: Diagnosis and treatment recommendations. J Urol. 2003;170(2 Pt 1):530–47. https://doi.org/10.1097/01.ju.0000078083.38675.79.

    Article  Google Scholar 

  7. Roehrborn CG, Siami P, Barkin J, Damiao R, Major-Walker K, Morrill B, et al. The effects of dutasteride, tamsulosin and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the CombAT study. J Urol. 2008;179(2):616–21; discussion 21. https://doi.org/10.1016/j.juro.2007.09.084.

    Article  CAS  PubMed  Google Scholar 

  8. Shelbaia A, Elsaied WM, Elghamrawy H, Abdullah A, Salaheldin M. Effect of selective alpha-blocker tamsulosin on erectile function in patients with lower urinary tract symptoms due to benign prostatic hyperplasia. Urology. 2013;82(1):130–5. https://doi.org/10.1016/j.urology.2013.03.026.

    Article  PubMed  Google Scholar 

  9. Olesovsky C, Kapoor A. Evidence for the efficacy and safety of tadalafil and finasteride in combination for the treatment of lower urinary tract symptoms and erectile dysfunction in men with benign prostatic hyperplasia. Ther Adv Urol. 2016;8(4):257–71. https://doi.org/10.1177/1756287216650132.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. • Jung JH, Kim J, MacDonald R, Reddy B, Kim MH, Dahm P. Silodosin for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. Cochrane Database Syst Rev. 2017;11:Cd012615. https://doi.org/10.1002/14651858.CD012615.pub2. Most comprehensive meta-analysis of Silodosin compared to other AB

    Article  PubMed  Google Scholar 

  11. Hellstrom WJ, Sikka SC. Effects of acute treatment with tamsulosin versus alfuzosin on ejaculatory function in normal volunteers. J Urol. 2006;176(4 Pt 1):1529–33. https://doi.org/10.1016/j.juro.2006.06.004.

    Article  CAS  PubMed  Google Scholar 

  12. Corona G, Tirabassi G, Santi D, Maseroli E, Gacci M, Dicuio M, et al. Sexual dysfunction in subjects treated with inhibitors of 5alpha-reductase for benign prostatic hyperplasia: a comprehensive review and meta-analysis. Andrology. 2017;5(4):671–8. https://doi.org/10.1111/andr.12353.

    Article  CAS  PubMed  Google Scholar 

  13. Favilla V, Russo GI, Privitera S, Castelli T, Giardina R, Calogero AE, et al. Impact of combination therapy 5-alpha reductase inhibitors (5-ARI) plus alpha-blockers (AB) on erectile dysfunction and decrease of libido in patients with LUTS/BPH: a systematic review with meta-analysis. Aging Male. 2016;19(3):175–81. https://doi.org/10.1080/13685538.2016.1195361.

    Article  CAS  PubMed  Google Scholar 

  14. Gacci M, Bartoletti R, Figlioli S, Sarti E, Eisner B, Boddi V, et al. Urinary symptoms, quality of life and sexual function in patients with benign prostatic hypertrophy before and after prostatectomy: a prospective study. BJU Int. 2003;91(3):196–200.

    Article  CAS  Google Scholar 

  15. Tubaro A, Carter S, Hind A, Vicentini C, Miano L. A prospective study of the safety and efficacy of suprapubic transvesical prostatectomy in patients with benign prostatic hyperplasia. J Urol. 2001;166(1):172–6.

    Article  CAS  Google Scholar 

  16. Sutherland DE, Perez DS, Weeks DC. Robot-assisted simple prostatectomy for severe benign prostatic hyperplasia. J Endourol. 2011;25(4):641–4. https://doi.org/10.1089/end.2010.0528.

    Article  PubMed  Google Scholar 

  17. Montesi L, Quaresima L, Tiroli M, Lacetera V, Cantoro U, Sbrollini G, et al. Improvement of lower urinary tract symptoms and sexual activity after open simple prostatectomy: prospective analysis of 50 cases. Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica. 2014;86(4):353–5. https://doi.org/10.4081/aiua.2014.4.353.

    Article  Google Scholar 

  18. Martin Garzon OD, Azhar RA, Brunacci L, Ramirez-Troche NE, Medina Navarro L, Hernandez LC, et al. One-year outcome comparison of laparoscopic, robotic, and robotic Intrafascial simple prostatectomy for benign prostatic hyperplasia. J Endourol. 2016;30(3):312–8. https://doi.org/10.1089/end.2015.0218.

    Article  PubMed  Google Scholar 

  19. Briganti A, Naspro R, Gallina A, Salonia A, Vavassori I, Hurle R, et al. Impact on sexual function of holmium laser enucleation versus transurethral resection of the prostate: results of a prospective, 2-center, randomized trial. J Urol. 2006;175(5):1817–21. https://doi.org/10.1016/s0022-5347(05)00983-3.

    Article  PubMed  Google Scholar 

  20. Muntener M, Aellig S, Kuettel R, Gehrlach C, Sulser T, Strebel RT. Sexual function after transurethral resection of the prostate (TURP): results of an independent prospective multicentre assessment of outcome. Eur Urol. 2007;52(2):510–5. https://doi.org/10.1016/j.eururo.2007.01.088.

    Article  PubMed  Google Scholar 

  21. Akman T, Binbay M, Tekinarslan E, Tepeler A, Akcay M, Ozgor F, Ugurlu M, Muslumanoglu A Effects of bipolar and monopolar transurethral resection of the prostate on urinary and erectile function: a prospective randomized comparative study. BJU Int 2013;111(1):129–136. doi:https://doi.org/10.1111/j.1464-410X.2012.11266.x.

    Article  Google Scholar 

  22. Poulakis V, Ferakis N, Witzsch U, de Vries R, Becht E. Erectile dysfunction after transurethral prostatectomy for lower urinary tract symptoms: results from a center with over 500 patients. Asian J Androl. 2006;8(1):69–74. https://doi.org/10.1111/j.1745-7262.2006.00088.x.

    Article  PubMed  Google Scholar 

  23. Pavone C, Abbadessa D, Scaduto G, Caruana G, Scalici Gesolfo C, Fontana D, et al. Sexual dysfunctions after transurethral resection of the prostate (TURP): evidence from a retrospective study on 264 patients. Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica. 2015;87(1):8–13. https://doi.org/10.4081/aiua.2015.1.8.

    Article  CAS  Google Scholar 

  24. • Dixon CM, Cedano ER, Pacik D, Vit V, Varga G, Wagrell L, et al. Two-year results after convective radiofrequency water vapor thermal therapy of symptomatic benign prostatic hyperplasia. Res Rep Urol. 2016;8:207–16. https://doi.org/10.2147/rru.s119596. One of few studies describing short term results of new BPH treatment

    Article  PubMed  PubMed Central  Google Scholar 

  25. •• McVary KT, Roehrborn CG. Three-year outcomes of the prospective, randomized controlled Rezum system study: convective radiofrequency thermal therapy for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Urology. 2018;111:1–9. https://doi.org/10.1016/j.urology.2017.10.023. Largest Convective RF thermal therapy study analyzing short term outcome of new BPH treatment

    Article  PubMed  Google Scholar 

  26. Chin PT, Bolton DM, Jack G, Rashid P, Thavaseelan J, Yu RJ, et al. Prostatic urethral lift: two-year results after treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia. Urology. 2012;79(1):5–11. https://doi.org/10.1016/j.urology.2011.10.021.

    Article  PubMed  Google Scholar 

  27. Woo HH, Chin PT, McNicholas TA, Gill HS, Plante MK, Bruskewitz RC, et al. Safety and feasibility of the prostatic urethral lift: a novel, minimally invasive treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). BJU Int. 2011;108(1):82–8. https://doi.org/10.1111/j.1464-410X.2011.10342.x.

    Article  PubMed  Google Scholar 

  28. McNicholas TA, Woo HH, Chin PT, Bolton D, Fernandez Arjona M, Sievert KD, et al. Minimally invasive prostatic urethral lift: surgical technique and multinational experience. Eur Urol. 2013;64(2):292–9. https://doi.org/10.1016/j.eururo.2013.01.008.

    Article  PubMed  Google Scholar 

  29. McVary KT, Gange SN, Shore ND, Bolton DM, Cowan BE, Brown BT, et al. Treatment of LUTS secondary to BPH while preserving sexual function: randomized controlled study of prostatic urethral lift. J Sex Med. 2014;11(1):279–87. https://doi.org/10.1111/jsm.12333.

    Article  PubMed  Google Scholar 

  30. Shore N, Freedman S, Gange S, Moseley W, Heron S, Tutrone R, et al. Prospective multi-center study elucidating patient experience after prostatic urethral lift. Can J Urol. 2014;21(1):7094–101.

    PubMed  Google Scholar 

  31. Cantwell AL, Bogache WK, Richardson SF, Tutrone RF, Barkin J, Fagelson JE, et al. Multicentre prospective crossover study of the ‘prostatic urethral lift’ for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. BJU Int. 2014;113(4):615–22. https://doi.org/10.1111/bju.12540.

    Article  PubMed  Google Scholar 

  32. Roehrborn CG, Gange SN, Shore ND, Giddens JL, Bolton DM, Cowan BE, et al. The prostatic urethral lift for the treatment of lower urinary tract symptoms associated with prostate enlargement due to benign prostatic hyperplasia: the L.I.F.T. Study. J Urol. 2013;190(6):2161–7. https://doi.org/10.1016/j.juro.2013.05.116.

    Article  PubMed  Google Scholar 

  33. • Perera M, Roberts MJ, Doi SA, Bolton D. Prostatic urethral lift improves urinary symptoms and flow while preserving sexual function for men with benign prostatic hyperplasia: a systematic review and meta-analysis. Eur Urol. 2015;67(4):704–13. https://doi.org/10.1016/j.eururo.2014.10.031. Most comprehensive sexual function analysis of prior PUL studies

    Article  PubMed  Google Scholar 

  34. •• Roehrborn CG, Barkin J, Gange SN, Shore ND, Giddens JL, Bolton DM, et al. Five year results of the prospective randomized controlled prostatic urethral L.I.F.T. study. Can J Urol. 2017;24(3):8802–13. Only study reporting long term outcomes for PUL

    PubMed  Google Scholar 

  35. Hamann MF, Naumann CM, Seif C, van der Horst C, Junemann KP, Braun PM. Functional outcome following photoselective vaporisation of the prostate (PVP): urodynamic findings within 12 months follow-up. Eur Urol. 2008;54(4):902–7. https://doi.org/10.1016/j.eururo.2008.05.003.

    Article  PubMed  Google Scholar 

  36. Kavoussi PK, Hermans MR. Maintenance of erectile function after photoselective vaporization of the prostate for obstructive benign prostatic hyperplasia. J Sex Med. 2008;5(11):2669–71. https://doi.org/10.1111/j.1743-6109.2008.00978.x.

    Article  PubMed  Google Scholar 

  37. Paick JS, Um JM, Kim SW, Ku JH. Influence of high-power potassium-titanyl-phosphate photoselective vaporization of the prostate on erectile function: a short-term follow-up study. J Sex Med. 2007;4(6):1701–7. https://doi.org/10.1111/j.1743-6109.2007.00574.x.

    Article  PubMed  Google Scholar 

  38. Reich O, Bachmann A, Schneede P, Zaak D, Sulser T, Hofstetter A. Experimental comparison of high power (80 W) potassium titanyl phosphate laser vaporization and transurethral resection of the prostate. J Urol. 2004;171(6 Pt 1):2502–4.

    Article  Google Scholar 

  39. Bruyere F, Puichaud A, Pereira H, Faivre d'Arcier B, Rouanet A, Floc'h AP, et al. Influence of photoselective vaporization of the prostate on sexual function: results of a prospective analysis of 149 patients with long-term follow-up. Eur Urol. 2010;58(2):207–11. https://doi.org/10.1016/j.eururo.2010.04.027.

    Article  PubMed  Google Scholar 

  40. Kumar A, Vasudeva P, Kumar N, Nanda B, Mohanty NK. Evaluation of the effect of Photoselective vaporization of the prostate on sexual function in a prospective study: a single center experience of 150 patients. J Endourol. 2012:150127063131006. https://doi.org/10.1089/end.2012.0376.

  41. Kumar A, Vasudeva P, Kumar N, Nanda B, Jha SK, Kumar R, et al. A prospective study on the effect of photoselective vaporization of prostate by 120-W high-performance system laser on sexual function. J Endourol. 2014;28(9):1115–20. https://doi.org/10.1089/end.2014.0170.

    Article  CAS  PubMed  Google Scholar 

  42. Naspro R, Bachmann A, Gilling P, Kuntz R, Madersbacher S, Montorsi F, et al. A review of the recent evidence (2006-2008) for 532-nm photoselective laser vaporisation and holmium laser enucleation of the prostate. Eur Urol. 2009;55(6):1345–57. https://doi.org/10.1016/j.eururo.2009.03.070.

    Article  PubMed  Google Scholar 

  43. Kim SH, Yang HK, Lee HE, Paick JS, Oh SJ. HoLEP does not affect the overall sexual function of BPH patients: a prospective study. Asian J Androl. 2014;16(6):873–7. https://doi.org/10.4103/1008-682x.132469.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Kim JK, Cho MC, Son H, Ku JH, Oh SJ, Paick JS. Patient perception of ejaculatory volume reduction after holmium laser enucleation of the prostate (HoLEP). Urology. 2017;99:142–7. https://doi.org/10.1016/j.urology.2016.09.037.

    Article  PubMed  Google Scholar 

  45. Elshal AM, El-Assmy A, Mekkawy R, Taha DE, El-Nahas AR, Laymon M, et al. Prospective controlled assessment of men’s sexual function changes following holmium laser enucleation of the prostate for treatment of benign prostate hyperplasia. Int Urol Nephrol. 2017;49(10):1741–9. https://doi.org/10.1007/s11255-017-1649-0.

    Article  PubMed  Google Scholar 

  46. Klett DE, Tyson MD, 2nd, Mmeje CO, Nunez-Nateras R, Chang YH, Humphreys MR. Patient-reported sexual outcomes after holmium laser enucleation of the prostate: a 3-year follow-up study. Urology 2014;84(2):421–426. doi:https://doi.org/10.1016/j.urology.2014.04.042.

    Article  Google Scholar 

  47. Placer J, Salvador C, Planas J, Trilla E, Lorente D, Celma A, et al. Effects of holmium laser enucleation of the prostate on sexual function. J Endourol. 2015;29(3):332–9. https://doi.org/10.1089/end.2014.0502.

    Article  PubMed  Google Scholar 

  48. Lang EK, Deutsch JS, Goodman JR, Barnett TF, Lanasa JA Jr, Duplessis GH. Transcatheter embolization of hypogastric branch arteries in the management of intractable bladder hemorrhage. J Urol. 1979;121(1):30–6.

    Article  CAS  Google Scholar 

  49. Bagla S, Martin CP, van Breda A, Sheridan MJ, Sterling KM, Papadouris D, et al. Early results from a United States trial of prostatic artery embolization in the treatment of benign prostatic hyperplasia. J Vasc Interv Radiol: JVIR. 2014;25(1):47–52. https://doi.org/10.1016/j.jvir.2013.09.010.

    Article  PubMed  Google Scholar 

  50. Wang MQ, Guo LP, Zhang GD, Yuan K, Li K, Duan F, et al. Prostatic arterial embolization for the treatment of lower urinary tract symptoms due to large (>80 mL) benign prostatic hyperplasia: results of midterm follow-up from Chinese population. BMC Urol. 2015;15:33. https://doi.org/10.1186/s12894-015-0026-5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. •• Pisco JM, Bilhim T, Pinheiro LC, Fernandes L, Pereira J, Costa NV, et al. Medium- and long-term outcome of prostate artery embolization for patients with benign prostatic hyperplasia: results in 630 patients. J Vasc Interv Radiol: JVIR. 2016;27(8):1115–22. https://doi.org/10.1016/j.jvir.2016.04.001. One of the few and largest trial describing PAE results for BPH

    Article  PubMed  Google Scholar 

  52. •• Napal Lecumberri S, Insausti Gorbea I, Saez de Ocariz Garcia A, Solchaga Alvarez S, Cebrian Lostal JL, Monreal Beortegui R, et al. Prostatic artery embolization versus transurethral resection of the prostate in the treatment of benign prostatic hyperplasia: protocol for a non-inferiority clinical trial. Res Rep Urol. 2018;10:17–22. https://doi.org/10.2147/rru.s139086. Only comparison study between TURP and PAE

    Article  PubMed  PubMed Central  Google Scholar 

  53. Pereira-Correia JA, de Moraes Sousa KD, Santos JB, de Morais PD, Lopes-da-Silva LF, Krambeck RL, et al. GreenLight HPS 120-W laser vaporization vs transurethral resection of the prostate (<60 mL): a 2-year randomized double-blind prospective urodynamic investigation. BJU Int. 2012;110(8):1184–9. https://doi.org/10.1111/j.1464-410X.2011.10878.x.

    Article  PubMed  Google Scholar 

  54. Kumar A, Vasudeva P, Kumar N, Nanda B, Jha SK, Mohanty N. A prospective randomized comparative study of monopolar and bipolar transurethral resection of the prostate and photoselective vaporization of the prostate in patients who present with benign prostatic obstruction: a single center experience. J Endourol. 2013;27(10):1245–53. https://doi.org/10.1089/end.2013.0216.

    Article  PubMed  Google Scholar 

  55. Wang Y, Shao J, Lu Y, Lu Y, Li X. Impact of 120-W 2-mum continuous wave laser vapoenucleation of the prostate on sexual function. Lasers Med Sci. 2014;29(2):689–93. https://doi.org/10.1007/s10103-013-1386-2.

    Article  PubMed  Google Scholar 

  56. Sonksen J, Barber NJ, Speakman MJ, Berges R, Wetterauer U, Greene D, et al. Prospective, randomized, multinational study of prostatic urethral lift versus transurethral resection of the prostate: 12-month results from the BPH6 study. Eur Urol. 2015;68(4):643–52. https://doi.org/10.1016/j.eururo.2015.04.024.

    Article  PubMed  Google Scholar 

  57. • Gratzke C, Barber N, Speakman MJ, Berges R, Wetterauer U, Greene D, et al. Prostatic urethral lift vs transurethral resection of the prostate: 2-year results of the BPH6 prospective, multicentre, randomized study. BJU Int. 2017;119(5):767–75. https://doi.org/10.1111/bju.13714. Only study comparing TURP versus PUL

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ryan Smith.

Ethics declarations

Conflict of Interest

Nicole Tuong, Katy Reines, Matthew Mikula, and Ryan Smith each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Male Sexual Dysfunction and Disorders

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tuong, N., Reines, K., Mikula, M. et al. Contemporary Review of BPH Medical and Surgical Treatments on Sexual Function. Curr Sex Health Rep 10, 293–304 (2018). https://doi.org/10.1007/s11930-018-0172-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11930-018-0172-3

Keywords

Navigation