Prospective, Multidimensional Evaluation of Sexual Disorders in Men after Laser Photovaporization of the Prostate

摘要

Introduction: A few studies have investigated the impact of photovaporization of the prostate (PVP) on sexual function and were mainly focused on erectile function. Aims: To comprehensively evaluate the impact of PVP on sexual function. Methods: A prospective evaluation involved sexually active patients needing surgical relief of bladder outlet obstruction due to benign prostatic enlargement in a single center between August 2007 and November 2011. All patients underwent PVP using the GreenLight HPS? 120W system (AmericanMedicalSystems, Minnetonka, MN, USA). Main Outcome Measures: Patients were evaluated preoperatively and postoperatively by International Prostate Symptom Score (I-PSS), I-PSS question 8, uroflowmetry parameters (maximum urinary flow rate [Qmax] and postvoid residual [PVR] volume), Danish Prostate Symptom Score Sexual items (DAN-PSSsex), and overall sexual satisfaction using a seven-grade Likert scale. Operative parameters and postoperative complications were also assessed. Preoperative and postoperative values were compared using the Pearson chi-square test and the Wilcoxon paired test. A multivariable model was used to investigate the determinants of variation of global sexual satisfaction. Results: One hundred and two consecutive patients with 12-month follow-up data were included in the analysis. Urinary parameters (I-PSS, Qmax, and PVR) were significantly improved compared with preoperative values. Compared with baseline, postoperative erection symptom score was not significantly different, whereas ejaculation symptom score was significantly worse. Global DAN-PSSsex score was unchanged, but DAN-PSSsex symptom score was worse (P=0.04) and DAN-PSSsex bother score was significantly improved (P0.0001). Global sexual satisfaction was significantly improved compared with baseline (P=0.02) and was significantly associated with I-PSS but not with erection and ejaculation score in a multivariable model. Conclusion: Ejaculation is the main sexual function impacted by PVP. Despite this, sexual satisfaction and bother due to sexual symptoms were significantly improved, probably due to the positive impact of urinary symptom relief.