Nancy Groves

-Filling a gap in the knowledge of the incidence of sexual dysfunction following Thulium YAG vaporesection (ThuVaRP), a recent study found that the risk of erectile dysfunction was 20%, while that of retrograde ejaculation was 56% in a group of patients who had been sexually active before the procedure. 

First author Raj P. Pal, MBChB, said that 11 of 54 patients treated for bladder outflow obstruction experienced worsening erectile dysfunction following surgery, and retrograde ejaculation occurred in 30 of the 54. In addition, diabetes and preoperative catheterization were found to be correlated comorbidities for retrograde ejaculation (

=.03, respectively); no comorbidities were associated with erectile dysfunction. 

Dr. Pal presented these findings at the AUA annual meeting in Atlanta, and they were published in 

 (2012; 88:165-9). At the time of the presentation, he was a urology resident at University Hospitals of Leicester and Leicester General Hospital, Leicester, United Kingdom, working with Masood A. Khan, MD, and colleagues. Dr. Pal is continuing his residency at Royal Derby Hospital, Derby, United Kingdom. 

The incidence of erectile dysfunction and retrograde ejaculation was reported at 12 months postoperatively. The effect of variables including cardiovascular disease risk factors, preoperative catheterization, and resection weight on the patients' postoperative sexual function was also evaluated. 

While 20% experienced worsening erectile function and 56% had retrograde ejaculation, the remainder of patients had either no change or an improvement in their erectile function or their ejaculate, Dr. Pal reported. 

Importance of problem depends on age 							

 Discussing the significance of these findings, Dr. Khan told 

 that their importance depends on the age and underlying sexual activity of the individual patient. 

"It appears that amongst the older population, only approximately 50% are sexually active. Hence, erectile dysfunction is less likely to be an issue in this age group," said Dr. Khan. "However, younger men will also require prostate surgery and are more likely to be sexually active. In this younger age group, it is likely to pose a greater problem. Retrograde ejaculation, although an irritation, is better tolerated and accepted than erectile dysfunction and is unlikely to have a major impact on the patient." 

"Patients will have to be fully counseled preoperatively that laser prostate surgery may have an adverse impact on erectile function as well as ejaculatory function," he added. "However, in a minority, sexual function may improve." 

In addition to the association discovered between two preoperative factors-diabetes and preoperative catheterization-and the outcome of the procedure, the investigators found an increased trend of erectile dysfunction in men over the age of 70 years who were diagnosed with hypertension and hypercholesterolemia; however, this was not statistically significant. 

While these findings may be helpful in understanding the risk profile of ThuVaRP, the study has several limitations, Dr. Pal said. These include the retrospective design, small size, and the lack of a standardized assessment tool. A larger, prospective study is needed, and the data from traditional transurethral resection procedures, for which ThuVaRP is an alternative, require updating, Dr. Khan said. 

Articles

Filling a gap in the knowledge of the incidence of sexual dysfunction following Thulium YAG vaporesection (ThuVaRP), a recent study found that the risk of erectile dysfunction was 20%, while that of retrograde ejaculation was 56% in a group of patients who had been sexually active before the procedure.

Sexual dysfunction seen with Thulium laser therapy for benign prostatic hyperplasia

-Photoselective vaporization of the prostate (PVP) and transurethral resection of the prostate (TURP) have no difference overall in intermediate-term functional outcomes for surgical treatment of lower urinary tract symptoms secondary to BPH, according to the results of a systematic review of studies with meta-analysis comparing the two procedures. 

Of nine randomized, controlled trials in which PVP was the intervention and TURP was the control, six found no difference in functional outcomes, while two favored TURP and one favored PVP, said first author Isaac Thangasamy, MD, of Hornsby Ku-Ring-Gai Hospital, Sydney, Australia. 

The safety and efficacy review encompassed biomedical databases from 2002 to 2012, combined with a search of the AUA and European Association of Urology conference proceedings from 2007 to 2011. The meta-analysis was performed with a random effects model; outcome variables were perioperative data, short- and long-term complications, and functional outcomes at 12 months. 

Although the overall results suggest that the two procedures are equivalent in functional outcomes, differences were found in several perioperative variables, said Dr. Thangasamy of the study, which was presented at the AUA annual meeting in Atlanta and published in 

Differences seen in perioperative variables 							

 PVP had a more favorable perioperative profile. The catheterization time and the length of the hospital stay were both significantly shorter in the PVP group by 1.91 days and 2.13 days, respectively (both, 

<.0001). The likelihood of blood transfusion was also lower in the PVP patients (

=.03). However, the operative time was shorter in the TURP group by 19.64 minutes (

"We believe that PVP is a very acceptable alternative to TURP," Dr. Thangasamy said. 

"PVP is associated with far less morbidity than TURP while still generating similar functional results of maximum urinary flow rates, symptom scores, and postvoid residual volumes. The benefit of a shorter length of hospital stay is further proof that PVP is a very suitable alternative," said Dr. Thangasamy, who worked on the study with Henry Woo, MD, and colleagues. 

 that further randomized trials analyzing PVP and TURP in certain high-risk patients, such as those on anticoagulants and those with larger prostates, will shed further light on the improved safety profile of PVP. 

"Many nonrandomized trials have already demonstrated this and, as such, obtaining ethical approval for randomized trials may prove to be difficult. We are also awaiting the results of a number of international multicenter randomized trials analyzing the latest 180-watt laser versus TURP." 

Dr. Thangasamy also noted that one of the problems with most studies on PVP is that they have included procedures performed by surgeons in their learning curve. 

"Now that PVP is a readily available technology, future randomized controlled trials should be multicenter and involve surgeons who are equally as experienced in performing PVP as surgeons are with performing TURP," he said. 

Photoselective vaporization of the prostate (PVP) and transurethral resection of the prostate (TURP) have no difference overall in intermediate-term functional outcomes for surgical treatment of lower urinary tract symptoms secondary to BPH.

Author | Nancy Groves

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Sexual dysfunction seen with Thulium laser therapy for benign prostatic hyperplasia

Transurethral resection of the prostate, photoselective vaporization of the prostate functional outcomes found equivalent