The impact of different BPH surgical techniques on erectile function

This study examined the impact of different surgical techniques for benign prostatic hyperplasia (BPH) on erectile function. Authors reported either no change or even an improvement in erectile function for most surgical techniques studied. Only photoselective vaporization (PVP) was associated with a decrease in erectile function. 

BPH can lead to bothersome urinary symptoms that impact quality of life. Surgery is often required to remove the enlarged prostate tissue. Transurethral resection of the prostate (TURP) is a minimally invasive surgery to treat BPH symptoms. It is the most commonly used alternative to open surgery. The TURP procedure involves the destruction of prostate tissue through a wire loop inserted into the urethra (the penile opening). Removing enlarged tissue from the prostate allows for better flow through the urethra and relieves symptoms of BPH.

Laparoscopic (or keyhole) simple prostate surgery (LSP) is another alternative to open surgery. This type of surgery involves multiple small incisions, rather than the one large incision used for open surgery. More recently developed minimally invasive procedures include GreenLight photoselective vaporization (PVP), plasmakinetic resection of the prostate (PKRP), plasmakinetic enucleation of the prostate (PKEP), holmium laser enucleation of the prostate (HoLEP), holmium laser resection of the prostate (HoLRP), and thulium laser procedure. Many of these techniques use high-intensity lasers inserted through the urethra to destroy enlarged prostate tissue.

Erectile dysfunction is a side effect associated with some BPH surgeries, while other techniques are believed to improve erectile function. More studies are needed to compare the impact of surgical procedures on erectile function.

The aim of this study was to analyze the impact of different surgical techniques on erectile function.

18 trials involving a combined total of 2,433 men with BPH were included in the analysis. All men were randomly assigned to undergo a surgical technique outlined above. Most trials compared a surgical technique to TURP or open surgery. Patients were followed for 3 to 36 months.

Overall, men who underwent either HoLEP, PKEP, Thulium laser, or TURP showed improved erectile function compared to before surgery. Further analysis showed that TURP improved erectile function only for men with normal erectile function before surgery. HoLEP and PKEP improved erectile function even for men with previous erectile dysfunction.

PVP was the only surgical technique associated with a decrease in erectile function. The remaining techniques showed no change in erectile function before and after surgery.

Authors concluded that of the 9 studied surgical techniques, only PVP was found to have a negative effect on erectile function. HoLEP, PKEP, Thulium laser, and TURP were associated with improved erectile function.