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Ejaculatory Function following Transperineal Laser Ablation versus TURP for Benign Prostatic Obstruction: A Randomized Trial

BJU Int. 2023 Mar 14. doi: 10.1111/bju.16008. Online ahead of print.


OBJECTIVES: To evaluate the reliability of trans-perineal laser ablation of prostate (TPLA) in preserving antegrade ejaculation compared to trans-urethral resection of prostate (TURP).

PATIENTS AND METHODS: In this single-center, prospective, randomized, open-label study, consecutive patients with indication to surgical treatment for benign prostatic obstruction (BPO) were enrolled between January 2020 and September 2021 (NCT04781049). Randomization defined two treatment arms: Group A: patients assigned to TPLA (experimental); Group B: patients assigned to TURP (standard). Primary endpoint was change in ejaculatory function (assessed by EJ-MSHQ) at 1 month after surgery. Secondary endpoints included comparison of visual analogue scale (VAS), changes in sexual function (by IIEF-5), ΔIPSS and ΔQoL, and Qmax improvement at 1-6 months, as appropriate.

RESULTS: Fifty-one patients (26 TPLA versus 25 TURP) were analyzed. No differences were found in the perception of pain assessed by VAS. No differences in IIEF-5 score were found between groups. Distribution of ejaculatory function assessed by the EJ-MSHQ remained unmodified after TPLA (p=0.2) while a median 30% decrease in EJ-MSHQ score was observed after TURP (p=0.01). Absence of antegrade ejaculation was reported in one patient within the TPLA group (18 patients s/p TURP). A statistically significant difference between the treatment groups was found in terms of postoperative Qmax (15.2 (IQR 13.5-18.3) versus 26.0 (IQR 22.0-48.0) ml/s, TPLA versus TURP, p<0.001). Both treatments significantly improved Qmax : mean 23.9 ml/s improvement s/p TURP (95% C.I. 17.1-30.7) versus 6.0 ml/s s/p TPLA (95% C.I. (5.0-7.0); and IPSS: mean 11.6 decrease (95% C.I. 9.7-13.5) versus 5.8 s/p TPLA (95% C.I. (2-9.6) with respect to baseline.

CONCLUSION: In our study, TPLA preserved ejaculatory function in 96% of cases in addition to providing significant relief from BPO.

PMID:36917033 | DOI:10.1111/bju.16008

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