Transurethral enucleation with bipolar surgery for prostatic obstructions safe for erectile function

Men with benign prostatic obstructions (BPO) can safely undergo transurethral enucleation with bipolar (TUEB) surgery without harbouring concerns that the procedure would compromise their erectile function (EF), according to a recent study.

“Because there are few data on how TUEB influences EF, unlike data on major transurethral surgery for BPO, we performed this prospective study to evaluate the influence of TUEB on EF,” the researchers said, adding that their findings indeed show that TUEB is both clinically effective for BPO symptoms and safe for patients’ EF.

A total of 51 TUEB patients (median age 75 years) were prospectively enrolled. Before surgery and at 3 and 12 months of follow-up, participants were assessed for maximum urinary flow rate (Qmax), postvoid residual urine (PVR), and quality of life (QoL). EF was measured using the International Index of Erectile Function-5 (IIEF-5), while the International Prostate Symptom Score (IPSS) was used to evaluate symptom burden.

Before operation, 23 patients had severe erectile dysfunction, as characterized by IIEF-5 scores ranging from 5–7 points. Meanwhile, 13, nine, and five patients had moderate, mild-to-moderate, and mild erectile dysfunction, respectively. Only one patient scored 22–25 points on IIEF-5 at baseline and was deemed to be free of erectile dysfunction. [PLoS One 2022;doi:10.1371/journal.pone.0272652]

TUEB surgery led to substantial improvements in urinary function. Qmax jumped from 7.6 mL/s at baseline to 12.9 and 15.2 mL/s at the 3- and 12-month follow-ups, respectively. Similarly, whereas PVR was 50 mL before surgery, it dropped to 0 mL at both postoperative time points. Symptom burden was likewise eased, with scores dropping to 9 and 6 at 3 and 12 months, respectively, from a median of 20.5 at baseline.

In turn, patient QoL improved, with scores decreasing from 5 preoperatively to 2 at both postoperative follow-ups.

Moreover, such benefits of TUEB did not come with notable EF side effects. Median IIEF-5 scores were not significantly changed, with the baseline median of 9 points dropping only slightly to 7 and 8 points at 3 and 12 months, respectively.

Analysis according to IIEF-5 score subgroups did not alter the principal findings. Among men with severe erectile dysfunction, median scores remained at 5 points throughout the study period. Scores were likewise stable in the one patient without erectile dysfunction, with median values staying at 23 points throughout.

Of note, those with mild-to-moderate erectile dysfunction at baseline saw slight deterioration in scores, which dropped from a median of 14 preoperatively to 13 and 11 at 3 and 12 months of follow-up, respectively. However, such an effect failed to reach statistical significance.

“The nonsignificant worsening of EF in [this subgroup] might be derived from not only the surgery itself but also aging or comorbidities, but we could not speculate as to the exact reason because the number or patients was small,” the researchers said. Nevertheless, “[w]hen patients with BPO are counseled prior to surgery, these findings might be an important factor.”

“A prospective multicenter study will be appropriate to assess the influence of other forms of transurethral surgery and TUEB on EF in patients with BPO,” they added.