World J Mens Health.  2017 Dec;35(3):156-162. 10.5534/wjmh.17027.

Changes in Erectile Function after Photoselective Vaporization of the Prostate with a 120-W GreenLight High-Performance System Laser: 2-Year Follow-Up

• Park J
• Cho SY
• Cho MC
• Jeong H
• Son H

• KMID: 2398564
• DOI: http://doi.org/10.5534/wjmh.17027

Abstract

PURPOSE
To evaluate the impact of photoselective vaporization of the prostate (PVP) with a 120-W GreenLight high-performance system on erectile function in a 2-year follow-up study.
MATERIALS AND METHODS
One hundred seventy-seven patients who underwent PVP during 2008 to 2012 were analyzed retrospectively. The patients were divided into 5 groups according to their preoperative 5-item International Index of Erectile Function (IIEF-5) scores: Group I (IIEF-5: 5~7, n=28), II (IIEF-5: 8~11, n=47), III (IIEF-5: 12~16, n=43), IV (IIEF-5: 17~21, n=34), and V (IIEF-5: 22~25, n=25). The patients were assessed before surgery and 6, 12, and 24 months after the PVP. Their International Prostate Symptom Score/quality of life, maximum urinary flow rate/post-void residual urine volume, and IIEF-5 scores were measured at each visit.
RESULTS
The mean age and presence of hypertension were significantly different among the 5 groups. Perioperative parameters and postoperative complication rates showed no statistical differences. After PVP, voiding parameters were significantly improved in all the groups and sustained during the 2-year follow-up. The postoperative IIEF-5 scores fell slightly overall, while group V showed the largest significant deterioration. In multivariate analysis, body mass index (BMI) was the only independent predictor of decreased erectile function after PVP.
CONCLUSIONS
Erectile function declined in all the groups after PVP, with the most extensive deterioration observed in patients with normal erectile function preoperatively. Preoperative BMI was the only independent risk factor for a meaningful decrease in erectile function after PVP.

Keyword

Erectile dysfunction; Laser therapy; Prostatic hyperplasia

MeSH Terms

Body Mass Index
Erectile Dysfunction
Follow-Up Studies*
Humans
Hypertension
Laser Therapy
Male
Multivariate Analysis
Postoperative Complications
Prostate*
Prostatic Hyperplasia
Retrospective Studies
Risk Factors
Volatilization*

Figure

• 

  Fig. 1 (A) Change in mean International Prostate Symptom Score (IPSS) scores from preoperative (Preop) visit to postoperative 2-year visit per each group (Groups were divided into 5 groups according to their Preop 5-item International Index of Erectile Function (IIEF-5) scores: Group I [IIEF-5: 5~7, n=28], II [IIEF-5: 8~11, n=47], III [IIEF-5: 12~16, n=43], IV [IIEF-5: 17~21, n=34], and V [IIEF-5: 22~25, n=25].); (B) Quality of life (QoL) scores; (C) Maximum flow rates (Qmax); and (D) post-void residual (PVR) urine volume. *p<0.05, significant change compared with preop visit.

• 

  Fig. 2 Change in mean International Index of Erectile Function (IIEF-5) scores from preoperative (preop) visit to postoperative 2-year visit for all patients and per each group (Groups were divided into 5 groups according to their preoperative 5-item IIEF-5 scores: Group I [IIEF-5: 5~7, n=28], II [IIEF-5: 8~11, n=47], III [IIEF-5: 12~16, n=43], IV [IIEF-5: 17~21, n=34], and V [IIEF-5: 22~25, n=25].), *p<0.05, significant change compared with preop visit. Combined table showed the number of patients at each visit per group. F/U: follow-up.

Reference

1. Kaiser FE. Sexuality and impotence in the aging man. Clin Geriatr Med. 1991; 7:63–72. PMID: 2004291.

2. Litwin MS, Nied RJ, Dhanani N. Health-related quality of life in men with erectile dysfunction. J Gen Intern Med. 1998; 13:159–166. PMID: 9541372.

3. Kubin M, Wagner G, Fugl-Meyer AR. Epidemiology of erectile dysfunction. Int J Impot Res. 2003; 15:63–71. PMID: 12605242.

4. Bruskewitz RC. Quality of life and sexual function in patients with benign prostatic hyperplasia. Rev Urol. 2003; 5:72–80. PMID: 16985624.

5. Cellek S, Cameron NE, Cotter MA, Fry CH, Ilo D. Microvascular dysfunction and efficacy of PDE5 inhibitors in BPH-LUTS. Nat Rev Urol. 2014; 11:231–241. PMID: 24619381.

6. Carson CC, Rosenberg M, Kissel J, Wong DG. Tadalafil: a therapeutic option in the management of BPH-LUTS. Int J Clin Pract. 2014; 68:94–103. PMID: 24341303.

7. Paick JS, Um JM, Kim SW, Ku JH. Influence of high-power potassium-titanyl-phosphate photoselective vaporization of the prostate on erectile function: a short-term follow-up study. J Sex Med. 2007; 4:1701–1707. PMID: 17672845.

8. Bruyère F, Puichaud A, Pereira H, Faivre d'Arcier B, Rouanet A, Floc'h AP, et al. Influence of photoselective vaporization of the prostate on sexual function: results of a prospective analysis of 149 patients with long-term follow-up. Eur Urol. 2010; 58:207–211. PMID: 20466480.

9. Hossack TA, Woo HH. Sexual function outcome following photoselective vaporisation of the prostate. Int Urol Nephrol. 2012; 44:359–364. PMID: 21779921.

10. Kavoussi PK, Hermans MR. Maintenance of erectile function after photoselective vaporization of the prostate for obstructive benign prostatic hyperplasia. J Sex Med. 2008; 5:2669–2671. PMID: 18785895.

11. Spaliviero M, Strom KH, Gu X, Araki M, Culkin DJ, Wong C. Does Greenlight HPS(™) laser photoselective vaporization prostatectomy affect sexual function? J Endourol. 2010; 24:2051–2057. PMID: 20964486.

12. Kumar A, Vasudeva P, Kumar N, Nanda B, Jha SK, Kumar R, et al. A prospective study on the effect of photoselective vaporization of prostate by 120-W high-performance system laser on sexual function. J Endourol. 2014; 28:1115–1120. PMID: 24754237.

13. Kang DH, Cho KS, Ham WS, Choi YD, Lee JY. A systematic review and meta-analysis of functional outcomes and complications following the photoselective vaporization of the prostate and monopolar transurethral resection of the prostate. World J Mens Health. 2016; 34:110–122. PMID: 27574594.

14. Guo Z, Jin X. The volume of prostate can impact the male sexual function following photoselective vaporization of the prostate: results of a prospective analysis of 128 patients with 2-year follow-up. Int Urol Nephrol. 2013; 45:961–966. PMID: 23779228.

15. Rosen R, Altwein J, Boyle P, Kirby RS, Lukacs B, Meuleman E, et al. Lower urinary tract symptoms and male sexual dysfunction: the multinational survey of the aging male (MSAM-7). Eur Urol. 2003; 44:637–649. PMID: 14644114.

16. Lee JH, Kwon H, Park YW. Association of lower urinary tract symptom/benign prostatic hyperplasia measures with international index of erectile function 5 in middle-aged policemen of Korea and the role of metabolic syndrome and testosterone in their relationship. Urology. 2013; 82:1008–1012. PMID: 24041675.

17. Egan KB, Burnett AL, McVary KT, Ni X, Suh M, Wong DG, et al. The co-occurring syndrome-coexisting erectile dysfunction and benign prostatic hyperplasia and their clinical correlates in aging men: results from the national health and nutrition examination survey. Urology. 2015; 86:570–580. PMID: 26210004.

18. Frieben RW, Lin HC, Hinh PP, Berardinelli F, Canfield SE, Wang R. The impact of minimally invasive surgeries for the treatment of symptomatic benign prostatic hyperplasia on male sexual function: a systematic review. Asian J Androl. 2010; 12:500–508. PMID: 20473318.

19. Bell JR, Laborde E. Update on the sexual impact of treatment for benign prostatic hyperplasia. Curr Urol Rep. 2012; 13:433–440. PMID: 23065462.

20. Son H, Song SH, Paick JS. Current laser treatments for benign prostatic hyperplasia. Korean J Urol. 2010; 51:737–744. PMID: 21165192.

21. Marra G, Sturch P, Oderda M, Tabatabaei S, Muir G, Gontero P. Systematic review of lower urinary tract symptoms/benign prostatic hyperplasia surgical treatments on men's ejaculatory function: Time for a bespoke approach? Int J Urol. 2016; 23:22–35. PMID: 26177667.

22. Demir O, Demir T, Kefi A, Secil M, Comlekci A, Yesil S, et al. Penile vascular impairment in erectile dysfunction patients with metabolic syndrome: penile Doppler ultrasound findings. Urol Int. 2009; 82:175–178. PMID: 19322005.

23. Franco G, De Nunzio C, Federico G, Laurenti C. Evaluation of sexual activity after prostatic surgery for benign prostatic hyperplasia assessed by pre-operative and post-operative questionnaire. Minerva Urol Nefrol. 2005; 57:331–334. PMID: 16247355.