Login to Access Video or Poster Abstract: MP02-17
Sources of Funding: None

Introduction

Benign prostatic obstruction (BPO) is the main cause of lower urinary tract symptoms (LUTS) in men over 50 years of age. This condition is highly prevalent and many men will undergo medical or surgical treatment leading to ejaculatory dysfunction with a potential negative impact on quality of life (QoL). Through urological generations, patients were warned of the almost inevitable risk of ejaculatory dysfunction as consequence of the treatment without asking their opinion on this issue. Our objective was to evaluate with a survey the patient’s wishes on ejaculatory function after surgical treatment for BPO.

Methods

All consecutive patients with LUTS and sexually active scheduled for BPO relief surgery in a tertiary reference center were included in this prospective evaluation. All patients were offered a surgical treatment with preservation of the ejaculatory function and were informed of the risk of failure and early recurrence of LUTS with the need of medication or surgery. Once information given, patients were asked their wish about the preservation of ejaculatory function.

Results

A total of 489 patients were included with a mean age of 68.3 years [43.2 - 93.8]. Among them, 175 (36%) preferred to undergo a surgery with attempt to preserve the ejaculatory function. The mean age of this group (group 1) was 61.8 [43.2 - 81.2] compared to 71.9 [52.8 - 93.8] for the group preferring a complete BPO relief surgery (group 2), p<0.001. At the preoperative evaluation, the mean IPSS symptom score was significantly lower in group 1 compared to group 2 (18.3 [1 - 35] versus 21 [3 - 35], p=0.02). Regarding the IPSS QoL score, there was no difference between the two groups, 5.7 [0 - 6] in group 1 versus 4.45 [1 - 5] in group 2, p=0.2. No difference in Qmax was observed: 9.3 mL/s [1 - 31] in group 1 versus 7.77 mL/s [2 - 26] in group 2, p=0.45. There was also no difference in prostate volume performed with transrectal ultrasound, 57.5 mL [17 - 220] in group 1 versus 62.3 mL [15 - 164] in group 2, p=0.13. About medication, 41% were under alpha-blockers in group 1 versus 51% in group 2 (p=0.06), and 9% were under 5-ARI in group 1 versus 24% in group 2, p<0.001.

Conclusions

This survey showed that more than one third of patients with indication of surgical treatment for BPO would like to preserve antegrade ejaculation despite of the risk of failure and early recurrence of LUTS. These patients were slightly younger than the others. This issue should be taken into consideration in the decision of the urologists which may change their surgical approach to preserve this function.

Funding

None