Ejaculatory Hood Sparing versus Standard Laser Photoselective Vaporization of the Prostate: Sexual and Urodynamic Assessment through a Double Blinded, Randomized Trial

No AccessJournal of UrologyAdult Urology1 Apr 2020Ejaculatory Hood Sparing versus Standard Laser Photoselective Vaporization of the Prostate: Sexual and Urodynamic Assessment through a Double Blinded, Randomized TrialThis article is commented on by the following:Editorial Comment Ahmed Elhussein Abolazm, Ahmed S. El-Hefnawy, Mahmoud Laymon, Ahmed B. Shehab-El-Din, and Ahmed M. Elshal Ahmed Elhussein AbolazmAhmed Elhussein Abolazm Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt More articles by this author , Ahmed S. El-HefnawyAhmed S. El-Hefnawy Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt More articles by this author , Mahmoud LaymonMahmoud Laymon Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt More articles by this author , Ahmed B. Shehab-El-DinAhmed B. Shehab-El-Din Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt More articles by this author , and Ahmed M. ElshalAhmed M. Elshal *Correspondence: Urology and Nephrology Center, Mansoura University, 35516 Elgomhoria St., Mansoura, DK, Egypt telephone: +2 050 2202222 [1643]; FAX: +2 050 2203717; E-mail Address: [email protected] Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000685AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: In a preliminary clinical trial we assessed the efficacy of ejaculatory hood sparing GreenLight™ Laser prostate photoselective vaporization to preserve antegrade ejaculation and urodynamic relief of obstruction compared to standard GreenLight prostate photoselective vaporization. Materials and Methods: Standard prostate photoselective vaporization was classically performed in 24 patients. Ejaculatory hood sparing vaporization was performed with preservation of the paracollicular and supracollicular tissue proximal to the verumontanum in 25 patients. Patients were assessed at baseline, and 1, 3, 6 and 12 months postoperatively using the Ej-MSHQ (Ejaculatory Domain of Male Sexual Health Questionnaire) and the IIEF-15 (International Index of Erectile Function-15). The I-PSS (International Prostate Symptom Score), uroflowmetry and post-void residual urine volume were reported at each followup visit. A standard urodynamic study was performed at 6 months. Results: Antegrade ejaculation was reported in 85% and 31.6% of patients after hood sparing and standard prostate vaporization, respectively (p=0.001). A significant reduction in the EJ-MSHQ score was reported after standard vaporization at 6 and 12 months (each p <0.001) with no significant difference after hood sparing vaporization (p=0.18 and 0.078, respectively). The median EJ-MSHQ score was 28.5 (range 1 to 33) and 27 (range 1 to 33) for hood sparing vaporization, and 9.5 (range 1 to 35) and 9 (range 0 to 33) for standard vaporization at 6 (p=0.005) and 12 months (p <0.001), respectively. Each group showed a decline in the mean total IIEF-15 score at 1 year but it was statistically significant only after standard vaporization (p=0.001). All urinary outcome measures revealed comparable significant improvement at all followups. Postoperative urodynamic assessment demonstrated a significant comparable decrease in the Bladder Outlet Obstruction Index from a median of 64 (range 21 to 207) to 23.5 (range 10 to 53) after hood sparing vaporization (p=0.005) and from 87 (range 38 to 186) to 19.5 (range 7 to 51) after standard vaporization (p=0.001). At 1 year the overall re-treatment rate was comparable in the 2 groups (p=0.26). Conclusions: In well informed, sexually interested patients ejaculatory hood sparing GreenLight prostate photoselective vaporization is feasible and effective treatment of small to moderate sized benign prostatic hyperplasia with a superior sexual function related outcome. Short-term relief of obstruction is objectively comparable to that of standard prostate photoselective vaporization. References 1. : Complications of transurethral resection of the prostate (TURP)—incidence, management, and prevention. Eur Urol 2006; 50: 969. Google Scholar 2. : Ejaculatory physiology and dysfunction. 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The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology2 Jan 2020Editorial Comment Volume 203Issue 4April 2020Page: 792-801Supplementary Materials Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordsprostatelaser therapyprostatectomyprostatic hyperplasiaejaculationMetricsAuthor Information Ahmed Elhussein Abolazm Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt More articles by this author Ahmed S. El-Hefnawy Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt More articles by this author Mahmoud Laymon Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt More articles by this author Ahmed B. Shehab-El-Din Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt More articles by this author Ahmed M. Elshal Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt *Correspondence: Urology and Nephrology Center, Mansoura University, 35516 Elgomhoria St., Mansoura, DK, Egypt telephone: +2 050 2202222 [1643]; FAX: +2 050 2203717; E-mail Address: [email protected] More articles by this author Expand All Registered in ClinicalTrials.gov (NCT02749604). The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Advertisement PDF downloadLoading ...