Evaluating minimally invasive treatment for BPH and the occurrence of ejaculatory dysfunction.

This article looked at the use of ejaculatory dysfunction (EjD) as a side effect of minimally invasive procedures for the treatment of benign prostatic hyperplasia (BPH). The authors found that the choice of treatment should be made by doctors together with their patients and should be based on effectiveness and cost-benefit. 

BPH is the non-cancerous increase in the size of the prostate gland. BPH can lead to urinary and sexual symptoms that significantly impact the quality of life (QoL) of patients. Most non-drug therapies involve the removal of a piece of the prostate that blocks urine flow by different modalities. These procedures have side effects, including EjD. One common type of EjD is retrograde ejaculation (RE). This means the semen passes into the bladder during ejaculation. It is important to review the optimal minimally-invasive treatment for BPH with the preservation of ejaculatory function.

There were 19 studies analyzed for this article. The authors looked at different minimally-invasive treatments for BPH and compared the occurrence of EjD among them.

Water vapor therapy or Rezum therapy involves vapor from heated water to remove tissue from the prostate gland blocking urine flow. Rezum therapy had no short-term decrease in sexual function. At 4-year follow-up, patients experienced a decrease in sexual function. However, no side-effects relating to EjD were reported. 

Prostatic urethral lift (PUL) involves the use of supports implanted through the urethra (the tube that passes urine) that hold an enlarged prostate out of place in order to open the urethra and allow passage of urine. PUL was associated with an increase in patients' self-reported sexual function. There was no difference in EjD from this procedure. 

Prostate artery embolization (PAE) blocks the blood vessels supplying the prostate with blood to shrink the prostate gland. PAE was associated with a 13.3% decrease of ejaculate volume in one trial. However, overall, PAE was not associated with RE or EjD.

Aquablation uses high-pressure water to remove prostate tissue. Aquablation was found to have a lower risk of developing EjD when compared to more invasive procedures such as transurethral removal of the prostate (TURP) in 4 clinical trials. In one trial,11% of men experienced EjD as a side effect from this treatment.

The authors concluded that minimally invasive therapies are effective in preventing side effects such as EjD in patients with BPH. The authors suggest that the choice of treatment should be based on doctor and patient led decision making.