Erectile Function May Be Best Spared by Urethral-Lift Prostate Surgery

By David Douglas

July 07, 2021

NEW YORK (Reuters Health) - In patients who undergo surgical interventions for benign prostatic obstruction (BPO) the prostatic urethral lift (PUL) procedure appears to result in better erectile function scores, according to a systematic review and network meta-analysis.

"The standard surgical procedure for benign enlargement of the prostate can result in difficulties with sexual functions for some men, including dry ejaculation or difficulty with erections," Dr. Prokar Dasgupta of King's College London told Reuters Health by email.

"Patients are increasingly asking if there are procedures that would maintain their sexual function; this study helpfully shows that a number of new options including 'UroLift' could help, but as these are new treatments we need to study their effects over time to see if they have lasting benefit," he added.

BPO causes lower-urinary-tract symptoms, which reduces quality of life, Dr. Dasgupta and colleagues note in European Urology. When medication is not effective, they add, surgery may be needed. And some men may prefer a "more definitive alternative" to pharmacologic therapy.

"An important consideration for any prostatic intervention, however, is the possible worsening of sexual function due to damage to cavernosal nerves and related structures," the authors write. "Though, despite risking sexual dysfunction, it is unclear if successful surgery could actually improve sexual function."

To investigate, the researchers analyzed data from 48 studies, including 33 randomized controlled trials (RCTs), involving 16 interventions in more than 5,100 patients.

The traditional standard approach, they say, has been monopolar transurethral resection of the prostate (mTURP), but other treatments have entered the armamentarium, including PUL, prostatic arterial embolization (PAE), holmium-laser enucleation (HoLEP) and bipolar enucleation (bEP).

PUL outperformed all other techniques in terms of erectile-function scores from month 1 through 24, at which point it was shown to be statistically significantly superior to mTURP.

Results for PUL were not available beyond 24 months, but up until 60 months there were no significant differences in comparisons among other interventions including mTURP and bipolar TURP.

The researchers point out that the "new tissue-sparing UroLift system uses implants to compress lobes and achieve urethral patency. Whether this explains the better performance of PUL is unclear."

They also observe that PUL was not used in larger prostates and that "further trials are required before robust recommendations can be made."

As senior author Dr. Oussama Elhage, of Guy's and St Thomas' NHS Foundation Trust, also in London, pointed out in an email to Reuters Health, although the current study "will help urologists advise patients who are undergoing treatment for prostate enlargement, its interpretation does need more data so we are calling for trials to allow direct comparison between treatments."

The study had no specific funding, and the authors report no conflicts of interest.

SOURCE: European Urology, online July 12, 2021.