Sexual dysfunction seen with Thulium laser therapy for benign prostatic hyperplasia

Key Points

Atlanta-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 (p=.04 and p=.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 Urologia Internationalis (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 Urology Times 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.