Is erectile function affected by the surgical intervention choice for benign prostatic obstruction?

This study evaluated the effect of different surgical interventions on sexual function in patients with benign prostatic obstruction (BPO). The authors concluded that the prostatic urethral lift (PUL) intervention provided significantly improved erectile function at 24 months.

Benign prostatic obstruction (BPO) is an overgrowth of the prostate that blocks the urethral opening (where the urine goes out of the bladder). Lower urinary tract symptoms (LUTS) such as incomplete urination, weak urine stream, and urinating during the night (nocturia) are commonly caused by BPO. LUTS can negatively impact the quality of life (QoL) of patients with BPO. Sexual dysfunction may also result from BPO and an association exists between sexual dysfunctional severity and LUTS.

BPO surgical treatments include procedures such as monopolar transurethral resection of the prostate (mTURP), prostatic urethral lift (PUL), and prostatic arterial embolization (PAE). The standard surgical treatment for BPO is mTURP. However, as with other surgical options, possible damage to cavernosal nerves in the penis and associated structures may worsen sexual dysfunction. Erectile function is not frequently assessed in research questionnaires. Presently, it remains unclear whether surgical options may actually improve sexual function in these patients.

This review included 48 papers including 5159 patients and 16 surgical options for BPO. Patients were followed-up at 1, 3, 6, 12, 18, 24, 36, 48, and 60 months. Different standardized questionnaires were used to evaluate sexual function.

Compared to other surgical options, PUL was associated with the best sexual outcomes at 1, 6, 12, and 24 months. PUL involves separating the enlarged prostate lobes to make the urethra (tube that passes urine out of the bladder) wider so that it is easier to urinate. At 24 months, erectile function improvement was significantly higher with PUL than alternative options including mTURP.

The second procedure in terms of improved erectile function up to 6 months was PAE. PAE involves reducing the blood supply to the prostate gland so it shrinks. 

At 36 and 60 months, there were no significant differences in sexual function among the procedures analyzed. However, there was no available data for more than 24 months for PUL.

The study showed that PUL provided benefits in terms of sexual function at 24 months in patients with BPO.

The review did not include clinical trials on robotic simple prostate surgery, intra-prostatic injection, and transurethral needle ablation. PUL was not studied beyond 24 months or in cases of larger prostates.