Can surgical treatment for benign prostatic hyperplasia improve sexual function? A systematic review.

INTRODUCTION: Erectile dysfunction is an established, well known risk of any operative management of benign prostatic hyperplasia (BPH). However, there are some cases reported in which surgical treatment has paradoxically improved erectile function. Here, we present a systematic review of the literature pertaining to the effect of surgery on sexual function, focusing on reports of improvement in erectile function following surgery. MATERIALS AND METHODS: We searched PUBMED, EMBASE, Web of Knowledge, and SCOPUS databases for the following keywords: (("sexual function" OR "erectile function") AND "improvement" AND "benign prostatic hyperplasia" AND "surgery"). RESULTS: Sixteen studies (total n = 2087) were reviewed which reported a significant improvement in any aspect of erectile function. Ten of these studies had a follow-up period of 12 months or more while five had a follow up less than 12 months. Various surgical methods were included in the 16 studies; however, five reported TURP outcomes specifically. Eleven studies reported outcomes using the International Index of Erectile Function (IIEF). Overall, a further 87 studies showed no significant change and 8 studies showed a significant reduction. CONCLUSIONS: The majority of studies report no change in erectile function following surgical intervention for BPH. There seems to be no obvious correlating factor between the studies reporting an improvement in erectile function. Further research is needed to guide us in how to consent our patients for erectile function outcomes for BPH surgery.

The role of Rezum ™ team ablation of the prostate in the treatment of patients with acute urinary retention secondary to benign prostatic hyperplasia. A single center, single surgeon case series and literature review.

OBJECTIVES: Acute urinary retention (AUR) is one of the most significant complication of benign prostatic hyperplasia (BPH). The gold standard surgical treatment for BPH, transurethral resection of the prostate (TURP), is not without significant side effects and a prolonged hospital stay. The aim of this study is to evaluate the role of Rezum ™ steam ablation in the treatment of patients with AUR secondary to BPH. METHODS: Patients who developed AUR and failed their trial without a catheter (TWOC) were recruited. They were counselled about the procedure and offered the treatment. Pre-operative, intraoperative and post operate data were collected. RESULTS: All patients were followed up for a mean period of 7.2 months. 100% of patients passed their TWOC and stopped taking any BPH medications after. There was an average of 43.8% decrease in TRUS volume and a fall of 52.5% in PSA value after intervention. The mean operation time was 8.8 min and mean duration in hospital was 5.8 h. No deterioration in sexual function was reported. CONCLUSIONS: Rezum ™ steam ablation of the prostate is safe, fast and effective day case procedure in treating patients with AUR secondary to BPH. All patients were satisfied with the functional outcomes.

Extra-Anatomic Stents in Ureteric Obstruction: Our Experience.

OBJECTIVES: To present our experience of the Detour extra-anatomic stent (EAS; Porges-Coloplast, Denmark) to bypass ureteric obstruction. Use of the EAS is indicated in patients with complex ureteric strictures or malignant disease, where long-term nephrostomy drainage is undesirable. MATERIALS AND METHODS: Between December 2001 and October 2017, 20 Detour EAS were implanted into 13 patients. The primary indication was ureteric obstruction or injury secondary to metastatic malignancy, or from treatment for malignancy. Five patients required bilateral EAS, with two patients having bilateral EAS following initial unilateral insertion. In 11 patients, the stent was inserted into their bladder, with 2 diverted into a double-barreled stoma. The mean age at the time of implantation was 64 years (range: 50-83 years), and the median follow-up was 12 months (range: 1.5-42 months). RESULTS: Four patients required stent revision for urinary leaks, and two developed recurrent urinary tract infections in their stent requiring intravenous antibiotics. All EAS continued to drain successfully following treatment or revision. One patient died due to complications from dislodgement of the stent, leading to laparotomy and intra-abdominal sepsis. Seven patients died due to progression of metastatic malignant disease, and the Detour EAS was functioning in all seven at time of death. The remaining five patients are well with functioning Detour EAS. CONCLUSIONS: The Detour EAS system provides a suitable alternative option for urinary diversion, affording a good quality of life to carefully selected patients with multiple comorbidities and malignant disease.

Can the UroLift prostatic implant device treat the symptoms of benign prostatic hypertrophy, avoid sexual dysfunction and reduce hospital TURP waiting times? A single centre, single surgeon experience and review of the literature.

BPH associated with LUTS and sexual dysfunction is common. We performed UroLift on 11 patients, average age 71 years (range 56-90). IPSS improved by an average of 9 points post-procedure. Pre-operatively their post-void residuals were 306.3 ml (range 120-499 ml SD [120.6]) and their QMAX was 7 ml/s (range 4-14 SD [2.8] ml/s). Post-procedure the post-void residual decreased by 35.4% at 4 months (mean difference - 106.3 ml). QMAX improved by an average of 1.7 ml/s, which was not statistically significant. No patients suffered any sexual dysfunction side effects and all patients were satisfied with their result. Hospital stay and theatre time were significantly reduced. Average length of stay was just 10.6 (6-18) hours and average theatre time just 18.7 (12-30) min. This is significantly faster than other surgery for LUTS. We therefore feel that there are significant benefits for both the patients, who are able to go home much faster, and also the hospital, who are able to perform far more surgeries for their patients. Patients also do not require an inpatient bed so patients should not be cancelled on the day of theatre.