V3-06: EJACULATION-SPARING PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE: EVALUATION OF THE EJACULATORY FUNCTION AND THE LOWER URINARY TRACT SYMPTOMS
Ejaculation disorder is a major complication of benign prostatic hyperplasia (BPH) surgeries. Photoselective Vaporization of the Prostate (PVP) has been reported at lower rates than other surgeries. However, we had experienced relatively high rate (57.1%) of dry orgasm with conventional PVP. We have devised alternative PVP technique to better preserve ejaculation function, and evaluated the result as well as the improvement of the lower urinary tract symptoms (LUTS).
To maintain the ejaculation function, adenomatous tissue around apex was intentionally and carefully preserved. (1) endpoint setting: irradiate 10mm proximal of the verumontanum with low power GreenLightRlaser; (2) median lobe vaporization to the endpoint; (3) extend the line of the endpoint to upper part of lateral lobe; (4) lateral lobe and anterior tissue vaporization to the endpoint; (5) check the bladder neck is opened and no obstructive tissue expect the tissue distal from the endpoint. This study was performed prospectively. From Feb 2014 to Apr 2015, 39 patients hoped to preserve their ejaculation function. The question about the ejaculation asked the patients preoperatively and 1 month after. To evaluate lower urinary symptom at 6 months follow up, International Prostate Symptom Score (IPSS), quality of life score (QOL score), maximum flow rate (Qmax) and post void residual (PVR) were measured. Outcomes evaluated at 1, 3 and 6 months, and prostate specific antigen (PSA) and prostate volume evaluated at 6 months.
24 of 39 patients attempted to ejaculate during the follow up period. Baseline mean (±standard deviation), age was 63.7±5.5 yrs, prostate size was 44.7±13.9 ml and PSA was 5.3±6.9 ng/ml. Mean preoperative, IPSS was 17.7±8.8 , QOL score was 4.7±1.5, Qmax was 12.3±5.9 ml/sec and PVR was 56.9±120.3 ml. The mean operative time was 58±24.5 min, the mean energy was 215±118 Kilojoules. Preserved ejaculation was 22 (91.7%) patients. 10 of 22 (45.5%) patients decreased quantity of sperm. 2 (8.3%) patients vanished antegrade ejaculation. Significantly (p
Ejaculation-sparing PVP preserved antegrade ejaculation at significantly higher rate, while improving LUTS. This is the useful technique for patients who desire to maintain fertility or satisfactory sexual life as well as good urination.