Ejaculation-Preserving Transurethral Resection of Prostate and Bladder Neck: Short- and Long-Term Results of a New Innovative Resection Technique Saladin Helmut Alloussi, MD, 1 Christoph Lang, MD, 2 Robert Eichel, MD, 3 and Schahnaz Alloussi, MD 1 Abstract Introduction: Loss of antegrade ejaculation is a risk with conventional resection of the prostate (transurethral resection of the prostate [TURP]). The aim of this study was to determine the short- and long-term preservation of antegrade ejaculation and functional results with the novel ejaculation-preserving TURP (epTURP). Patients and Methods: Prospective evaluation of 89 consecutive patients with bladder outlet obstructions aged 27 to 78 years, enrolled from June 2001 to January 2005. Endpoints were change in objective (uroflowmetry, postvoid residual [PVR]), and subjective (International Prostate Symptoms Score [IPSS], Life Quality Index [LQI]; International Index of Erectile Function-5 [IIEF-5 + ] with two additional questions) measures of function. All patients received follow-up examinations at 3 and ‡ 60 months. Results: Overall, 87 and 63 patients were evaluated after 3 and 60 months, respectively. Antegrade ejaculation was preserved in 79 of 87 (90.8%) patients at 3 months. Significant improvements in maximum flow rate (+ 14.3 mL/s), micturition volume (+ 71.6 mL), and PVR (- 59 mL; p £ 0.002 for all) were observed at 3 months. Micturition symptoms, as measured by IPSS and LQI, were also significantly reduced (mean change of 18.3 and 2.9, respectively; p < 0.001). Improvements were maintained at 60 months. No serious adverse events were reported. Eight (12.7%) patients received a second epTURP due to the development of bladder neck scar tissue during long-term follow-up. Conclusion: Antegrade ejaculation was preserved with the use of epTURP with excellent outcome. Observed symptomatic and functional outcomes were comparable with conventional TURP. The results from this study underline the necessity of reviewing the old concept of ejaculation physiology. Introduction B ladder outlet obstructions (BOO) are one of the major disorders in the aging male. 1 The most common etiology of BOO in elderly men above the age of 60 years is benign prostate hyperplasia, but younger men (< 50 years old) can also experience subvesical obstruction from a small but obstructive prostate. 2 Surgical intervention (transurethral resection of the prostate [TURP]) after failure of first-line treatment can achieve highly satisfying symptomatic and functional outcomes in patients with BOO. Ejaculation is one of the fundamental domains of male sexual function. 3 An almost inevitable adverse event of the conventional TURP is the loss of antegrade ejaculation, seen in 65%–80% of patients. 4–6 The use of a-receptor antagonists is also known to cause a loss in antegrade ejaculation. 7 Aside from peri- and postoperative morbidities, such as bleeding and TURP syndrome, the loss of ejaculation represents a major reason for the avoidance of surgical treatment. This is a particular issue among young people who hesitate to agree to the TURP procedure due to the fear of loss of ejaculation. Losing the ability to ejaculate often leads to a subsequent decrease in sexual pleasure, which has psychosocial implica- tions but can also impact on aspects related to their cultural background, desire for children, and sexual life. 3 According to the current theory of ejaculation, the loss of bladder neck function after resection is attributed to the loss of antegrade ejaculation. 8–10 However, clinical, physiological, and anatomical findings challenge the current theory of the ejaculation mechanism. Videourodynamic observations show a persistent opened internal bladder neck in patients able to ejaculate antegradely whereas patients who have lost 1 Department of Urology, Academic Teaching Hospital of University of Saarland, Sta ¨dtisches Klinikum Neunkirchen, Neunkirchen, Germany. 2 Department of Urology, Knappschaftskrankenhaus Sulzbach, Sulzbach, Germany. 3 Urological Office, Neunkirchen, Germany. A video demonstrating this technique is available at www.liebertpub.com/end JOURNAL OF ENDOUROLOGY Volume 28, Number 1, January 2014 ª Mary Ann Liebert, Inc. Pp. 84–89 DOI: 10.1089/end.2013.0093 84 Downloaded by 27.79.76.86 from www.liebertpub.com at 05/11/23. For personal use only.
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