Sexual side effects from surgical treatment of benign prostatic hyperplasia (BPH) and associated lower urinary tract symptoms (LUTS) are “underappreciated by urologists,” experts say. Yet, these side effects are important factors when patients consider treatments.
Many men develop LUTS associated with BPH after age 50. LUTS include problems with urination and occur because the growing prostate gland presses on the urethra. Cases of erectile dysfunction (ED) also tend to increase as men age. Taken together, these issues can interfere with men’s quality of life.
Given that men are staying sexually active as they get older and rate sex as important, the researchers conducted a literature review to determine how surgical and minimally invasive treatments for BPH/LUTS affect men’s sexual health. They focused their review on erectile and ejaculatory function.
In the researchers’ view, many of the studies consulted were not conducted well. For example, some studies on open prostatectomy were not prospective in nature and did not use validated instruments like the International Index of Erectile Function (IIEF). They noted that, in general, sexual side effects of transurethral resection (TURP) procedures were “poorly described.” They added “The literature is littered with underpowered, uncontrolled, single-center, cohort studies of a poor quality.”
With these considerations in mind, they did discuss rates of sexual dysfunction after certain procedures. They explained that the incidence rate of ED after open prostatectomy was about 12.5%. According to a 1994 clinical practice guideline, ED rates were 16.25% for a retropubic procedure and 17.7% when the transvesical technique was used. They estimated that the rate of ejaculatory dysfunctions, such as retrograde ejaculation, was around 80% for open prostatectomy.
TURP, considered the gold standard for BPH/LUTS treatment, had an estimated 13.4% rate of postoperative ED according to a 1994 guideline. Some studies found that ED after TURP was more likely to be caused by risk factors like age rather than the procedure itself. About 65% to 70% of patients have ejaculatory dysfunction after TURP, they said.
For transurethral needle ablation of the prostate (TUNA), the researchers found only one randomized controlled trial that discussed sexual side effects using a validated measure (the IIEF). This study compared TUNA and TURP procedures and found that no men in the TUNA group developed ED, compared to 12% in the TURP group. None of the TUNA patients experienced retrograde ejaculation, but 48.5% of the TURP patients did. Other studies suggested that TUNA had fewer sexual side effects than TURP.
Sexual side effects of transurethral microwave therapy (TUMT) were also considered. Many studies showed that TUMT had lower rates of postoperative erectile and ejaculatory dysfunction when compared to TURP.
In their conclusion, the authors stressed the importance of discussing potential sexual side effects of BPH/LUTS treatments with patients. These considerations “play a prominent role in patient motivation, acceptance of bother, and decision making concerning surgical intervention, thus creating a potential disparity between provider and patient,” they wrote.
The study was first published online in December 2013 in Sexual Medicine Reviews.
Resources
Sexual Medicine Reviews
Becher, Edgardo F. MD, PhD and Kevin T. McVary MD, FACS
“Surgical Procedures for BPH/LUTS: Impact on Male Sexual Health”
(Full-text. First published online: December 17, 2013)
http://onlinelibrary.wiley.com/doi/10.1002/smrj.20/full