Influence of holmium laser enucleation of the prostate on erectile function: results of a multicentric analysis of 235 patients.

PURPOSE: Preserved sexual function is one of the endpoints of the surgical management of lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Our aim was to investigate the evolution of erectile function (EF) at 3 and 12 months after holmium laser enucleation of the prostate (HoLEP). METHODS: A multicentric retrospective study was performed including 235 sexually active patients who underwent HoLEP between January 2016 and June 2017. Evaluation of EF was carried out with the five-item version of the International Index of Erectile Function (IIEF-5) completed before surgery and at 3 and 12 months after surgery. A change of more than five points in either direction in the IIEF-5 score compared to baseline was considered as an improvement or impairment of EF. RESULTS: No significant differences were found between median pre-operative IIEF-5 and median scores at 3 and 12 months (p = 0.15 and p = 0.45). At 3 and 12 post-operative months, respectively, 10% and 13% of patients reported an improvement, whereas 15% and 16% reported an impairment. The reduction in IIEF-5 score was only statistically significant within the sub-group of patients with normal pre-operative EF (p < 0.001). In this sub-group, 15% of patients reported a decrease of more than five points in total IIEF-5 score. CONCLUSION: This multicentric evaluation confirmed that median IIEF-5 score was not significantly impaired after HoLEP. However, for patients with normal pre-operative EF, a significant decrease in EF after HoLEP was observed. These results may be taken into account when counselling patients before HoLEP.

Laparoscopic Management of Pelvic Organ Prolapse in a Kidney Transplant Recipient.

This is a report of a laparoscopic double mesh sacrocolpopexy performed in the setting of a 73-year-old woman carrying a grafted kidney. The patient had a vaginal prolapse of the anterior and posterior floor without urinary incontinence. Despite immunosuppression due to anti-rejection treatments and the presence of kidney transplant in left iliac fossa, laparoscopic intervention with the introduction of prosthetic material was conducted. The intervention showed no major difficulty in its implementation and the postoperative course was uneventful. The long-term follow-up will confirm the tolerance of a prosthetic material.