Giovanni E Cacciamani1, Frederico Cuhna2, Alessandro Tafuri2,3, Aliasger Shakir2, Andrea Cocci4, Karanvir Gill2, Juan Gómez Rivas5, Aurus Dourado6, Domenico Veneziano7, Zhamshid Okhunov8, Paolo Capogrosso9, Pierre A Hueber2, Marteen Alberseen10, Andre Abreu2, Filippo Migliorini3, Cristian Fiori11, Antonio B Porcaro3, Francesco Porpiglia11, Mihir Desai2, Giorgio I Russo12. 1. USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA - giovanni.cacciamani@med.usc.edu. 2. USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA. 3. Department of Urology, University of Verona, Verona, Italy. 4. Department of Urology, Careggi Hospital, University of Florence, Florence, Italy. 5. Department of Urology, La Paz Hospital, Madrid, Spain. 6. Department of Urology, São Marcos Hospital, Piauí, Brazil. 7. Department of Urology and Renal Transplantation, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy. 8. Department of Urology, University of California, Irvine, CA, USA. 9. Department of Urology, San Raffaele Hospital, Milan, Italy. 10. Department of Urology and Pediatric Urology, Medicine University Mainz, Mainz, Germany. 11. Department of Urology, San Luigi Hospital, University of Turin, Turin, Italy. 12. Department of Urology, University of Catania, Catania, Italy.
Abstract
INTRODUCTION: Despite the high rate of resolution, ejaculatory dysfunction still is the most common side effect related to surgical treatment of bladder outlet obstruction (BOO). The aim of the present systematic review was to compare several technological treatment modalities for the management of lower urinary tract symptoms/BOO in terms of functional and sexual outcomes. EVIDENCE ACQUISITION: All English language randomized controlled trials assessing the impact of different endoscopic treatments for BOO were evaluated. We followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement to evaluate PubMed®, Scopus®, and Web of Science™ databases (up to June 2019). EVIDENCE SYNTHESIS: Our electronic search identified a total of 2221 papers in PubMed, Scopus, and Web of Science. Of these, 142 publications were identified for detailed review, which yielded 21 included in the present systematic review. All groups appeared similar with regards to preoperative IPSS/AUA Score, Qmax, and prostate volume (cc). Patients undergoing endoscopic treatments using ThuLEP, Greenlight or Prostate Artery Embolization techniques had lower-but not statistically significant- relative risk (RR) of retrograde ejaculation compared with conventional transurethral resection of the prostate (TURP) (RR: 0.90; P=0.35; RR: 0.71; P=0.1; RR0.73; P=0.11). Efficacy of those techniques was equal to TURP. CONCLUSIONS: Data reporting anterograde ejaculation preservation after endoscopic treatment in patients with benign prostatic enlargement are sparse and heterogeneous. Pooled analyses suggest that new technological alternatives to conventional TURP might improve sexual outcomes, especially for non-ablative treatments.
INTRODUCTION: Despite the high rate of resolution, ejaculatory dysfunction still is the most common side effect related to surgical treatment of bladder outlet obstruction (BOO). The aim of the present systematic review was to compare several technological treatment modalities for the management of lower urinary tract symptoms/BOO in terms of functional and sexual outcomes. EVIDENCE ACQUISITION: All English language randomized controlled trials assessing the impact of different endoscopic treatments for BOO were evaluated. We followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement to evaluate PubMed®, Scopus®, and Web of Science™ databases (up to June 2019). EVIDENCE SYNTHESIS: Our electronic search identified a total of 2221 papers in PubMed, Scopus, and Web of Science. Of these, 142 publications were identified for detailed review, which yielded 21 included in the present systematic review. All groups appeared similar with regards to preoperative IPSS/AUA Score, Qmax, and prostate volume (cc). Patients undergoing endoscopic treatments using ThuLEP, Greenlight or Prostate Artery Embolization techniques had lower-but not statistically significant- relative risk (RR) of retrograde ejaculation compared with conventional transurethral resection of the prostate (TURP) (RR: 0.90; P=0.35; RR: 0.71; P=0.1; RR0.73; P=0.11). Efficacy of those techniques was equal to TURP. CONCLUSIONS: Data reporting anterograde ejaculation preservation after endoscopic treatment in patients with benign prostatic enlargement are sparse and heterogeneous. Pooled analyses suggest that new technological alternatives to conventional TURP might improve sexual outcomes, especially for non-ablative treatments.
Authors: Gregor Kadner; Francesco Porpiglia; Daniele Amparore; Cristian Fiori; Massimo Valerio; Claude Schulman; Ioannis Giannakis; Sabrina De Cillis Journal: Prostate Cancer Prostatic Dis Date: 2020-10-01 Impact factor: 5.554