V403: The impact of Ejaculation-Preserving Photo-selective Vaporization of the Prostate (EP-PVP) on lower urinary tract symptoms and ejaculatory function: results of a multicenter study

Video

Introduction and Objectives
Orgasmic dysfunction and dry orgasm are some of the most common complications of benign prostate surgery and has been reported in up to 90% of these patients post-operatively. Besides infertility, dry and diminished orgasm may decrease sexual satisfaction. There is no agreement of the mode of causation, with both retrograde ejaculation and ejaculatory duct obstruction having been proposed. In this video we aimed to describe the Ejaculation-Preserving Photo-selective Vaporization of the Prostate (EP-PVP) technique along with the presentation of the outcomes.

Methods
From 2004 to 2012, 160 men with benign prostatic hyperplasia who wished to preserve their ejaculation were treated with EP-PVP technique. The technique involves three steps in order to improve ejaculatory outcomes: 1) preservation of bladder neck muscle fibers; 2) preservation of precollicular tissue; 3) preservation of paracollicular prostate tissue (ejaculatory hood). Patients' charts were retrospectively reviewed for preoperative and postoperative International Prostate Symptom Score (IPSS), AUA quality of life score, maximum flow rate (Qmax) and post-void residual volume (PVR). Postoperative ejaculation was also evaluated and scored as no ejaculation (0), low-volume ejaculation (1), and normal ejaculation (2). Duration of follow up was between 3 to 74 months with average of 28 months.

Results
The mean patient's age was 62 years old (range, 43-80). Prostate volume was between 17 to 230 cc, with mean volume of 64 cc. Average laser energy was 162 Kilojoules with the range of 9.5 to 735 Kilojoules. IPSS score pre- and post-procedure were 20.3±7.2 and 5.3±3.6, respectively. Quality of life score was dropped on average from 4.2 to 1.2. The mean pre-operative Qmax was 8.4±3.5 ml/min which significantly improved at final fallow-up (20.6±8.3 ml/min). Furthermore, there is a significant reduction in PVR, postoperatively. Post-op ejaculatory function evaluation showed that 88 (56 %) patients had normal antegrade ejaculation and 48 (30.6%) patients had diminished ejaculation after surgery, while 21 (13.4%) patients reported that they had no ejaculation.

Conclusions
EP-PVP technique is successful in preserving ejaculation function in 86.6% of patients, post-PVP. This technique does not compromise LUTS outcomes, as is reflected in post procedure IPSS, Qmax and PVR. Further detailed multicenter reporting of outcomes with this new technique, in addition to a prospective study is planned by the authors.

Funding: none