This study evaluated how different surgical procedures used to treat enlarged prostates can affect sexual function.

While sexual dysfunction is common after most surgical procedures, researchers concluded that some procedures are better than others in preserving sexual function.

Benign prostatic hyperplasia (BPH) can lead to bothersome symptoms that often require surgery to remove enlarged prostate tissue. Over the past decade, less invasive surgical procedures have been developed. However, many men report ejaculatory dysfunction (problems such as premature, painful, or no ejaculation) after surgery. The effectivity of different surgical procedures with respect to preserving sexual function has not yet been fully studied.

42 separate randomized trials, including a combined total of 3,857 men with BPH, were included in this study. Rates of ejaculatory dysfunction were compared across different surgical procedures.

Overall, transurethral resection of the prostate (TURP, the current standard of care procedure) was the most commonly used procedure for treating enlarged prostates. On average, 66% of men undergoing TURP experienced ejaculatory dysfunction after surgery. Rates of ejaculatory dysfunction were not influenced by the size of the enlarged prostate before the procedure.

While laser procedures resulted in fewer complications and shorter hospital stays, they generally caused similar rates of ejaculatory dysfunction. On average, 54% of men undergoing a thulium laser procedure experienced ejaculatory dysfunction after surgery. Rates were somewhat lower in men undergoing photo-selective vaporization of the prostate (such as the GreenLight laser procedure), with 42% reporting ejaculation problems. The holmium laser technique was associated with ejaculatory dysfunction in 76% of men when the enlarged tissue was destroyed (a HoLEP procedure), and in 96% of men when the enlarged tissue was resected (a HoLRP procedure).

When compared to TURP, the only laser procedures associated with significantly preserved sexual function were contact laser prostatectomy (6% of men reporting ejaculatory dysfunction), contact laser vaporization (4% of men reporting sexual dysfunction), and visual laser ablation of the prostate (18% of men reporting dysfunction).

Other procedures that were found to preserve sexual function significantly better than TURP included transurethral incision of the prostate (TUIP), transurethral needle ablation, and transurethral microwave thermotherapy. Approximately one in five men undergoing these procedures reported ejaculatory dysfunction. However, such procedures are often considered less effective in treating urinary symptoms, compared to TURP or laser techniques.

A recently developed treatment option called prostatic urethral lift (UroLift), is associated with very few complications and no significant side-effects related to sexual function. In addition, UroLift has previously been shown to be as effective as the current standard-of-care TRUP. However, the long-term effects of this new procedure are still under investigation.

This review concluded that ejaculatory dysfunction is a relatively common side-effect of most surgical procedures to treat BPH. Additional high-quality studies are needed to better investigate the preservation of sexual function during the surgical treatment of BPH.