Evaluating the effectiveness of holmium laser enucleation of the median lobe of the prostate on preserving sexual and urinary function in patients with benign prostatic hyperplasia.

This study evaluated the effectiveness of holmium laser enucleation of the median lobe of the prostate (HoLEP) on preserving sexual and urinary function in patients with benign prostatic hyperplasia (BPH). The data showed that HoLEP significantly improved urinary function with preservation of ejaculation (sexual function) in these patients.

BPH is the non-cancerous increase in the size of the prostate gland. BPH can cause lower urinary tract symptoms (LUTS) such as frequent urination, trouble starting to urinate, and a weak stream while urinating. Other symptoms include urine leakage (incontinence) and discomfort passing urine. LUTS/BPH can lead to problems relating to the quality of life and mental health issues. Sexual function can also be negatively impacted.

Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive procedure to treat BPH. HoLEP allows for the destruction of prostate tissue with a laser inserted into the urethra (the penile opening). HoLEP is generally well-tolerated and associated with relatively few complications. However, the effectiveness of HoLEP with selective enucleation of the median lobe on preserving sexual and urinary function in patients with BPH is still unclear.

This study involved 55 patients with BPH. All patients received treatment with HoLEP with selective enucleation of the median lobe. The urinary and sexual functions were measured by patient-reported questionnaires. These questionnaires measured the symptoms of LUTS, quality of life (QoL), sexual function, maximum urine flow rate, and the volume of urine left in the bladder after urination. Patients were evaluated before and after treatment.

HoLEP treatment significantly improved the urinary symptom scores, quality of life scores, and the amount of urine left after emptying the bladder.

None of the patients experienced stress urinary incontinence (SUI; urine leakage due to physical activity, sneezing, or laughing).

40 patients were sexually active. Of those men, 35 reported normal ejaculation, 3 had retrograde ejaculation (when semen enters the bladder instead of emerging through the penis) and 2 had new ejaculatory dysfunction.

This study concluded that HoLEP significantly improved urinary function with preservation of ejaculation (sexual function) in patients with BPH.   

This study looked back in time at medical records. The sample size was small and the follow-up period was too short. All patients were treated by a single surgeon which could influence the outcomes. Larger studies with longer follow-up periods are necessary to validate the findings.