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Urethral-sparing robot-assisted simple prostatectomy preserves ejaculatory function

European Urology
Reuters Health - 17/11/2020 - Urethral-sparing robot-assisted simple prostatectomy (usRASP) preserves ejaculatory function while relieving lower-urinary-tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH), according to findings from a prospective study.

"The most interesting results is the high percentage of the patients that maintain anterograde ejaculation," Dr. Francesco Porpiglia of "San Luigi Gonzaga" Hospital, in Turin, Italy, told Reuters Health by email. "Surprising is the fact that the ejaculate volume is normal with normal spermiogram values. Therefore, the ejaculation can be considered physiologically similar to young health men."

Retrograde ejaculation is one of the most frequent adverse effects following treatment of BPH, and it has a major impact on patients' quality of life. Urethral-sparing simple prostatectomy, whether open or laparoscopic, has been associated with preservation of anterograde ejaculation.

In their report in European Urology, Dr. Porpiglia and colleagues describe their prospective series of 92 patients with large BPH who underwent usRASP and compare outcomes with those of 92 patients from a prospectively maintained database who underwent standard RASP. They also explain the surgical technique in detail.

Among the patients who underwent usRASP, the median age was 67 years, the median prostate volume was 140 mL, and 34 patients (36.0%) had a median lobe. Most patients (76%) had normal ejaculation preoperatively or before starting alpha-blocker therapy.

The median operative time was 110 minutes, and there were no intraoperative complications. The median specimen weight of the resected adenoma was 90 g.

During a follow-up of 12 months on average, with a minimum of nine months, potency was preserved and there were no differences between the pre- and postoperative values of International Index of Erectile Function.

Among the 70 men who had ejaculation before the intervention, 63% maintained anterograde ejaculation at one month. This value increased to 80% at three months and remained stable through 12 months postoperatively.

Patients showed a progressive increase in spermatic volume from the first to the sixth month of follow-up, and the mean number of spermatozoa per millimeter at six months was 14 million.

Ejaculatory function as reported by the patients improved through month 3 of follow-up, after which it remained stable through month 12.

The ejaculation preservation rate and ejaculatory function were significantly higher for usRASP than for RASP during the entire follow-up period.

Micturition outcomes improved to a similar extent after usRASP and standard RASP.

"This technique could be offered in all the patients with medium or large prostate adenoma motivated to maintain normal ejaculation," Dr. Porpiglia said. "The only limit is represented by the presence of a large median lobe."

"Today, all the different surgical options should be proposed to the patient, and the physicians should consider the possibility of maintaining normal ejaculation during counseling in motivated patients," he said.

By Will Boggs MD

SOURCE: https://bit.ly/3j7CuNY European Urology, online October 5, 2020.

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