[1] Ejaculation-preserving transurethral bipolar prostatectomy: Enucleation vs resection

Objective: To assess the feasibility and safety of a novel ejaculation-preserving transurethral bipolar resection of prostate (ep-TUBRP) and compare the resection technique to the enucleation technique. Methods: After obtaining local ethics approval, 100 consecutive patients with benign prostatic obstruction (BPO) and normal sexual activity were enrolled from June 2015 to June 2016. These patients were selectively randomised into two groups; 50 patients in each group. Group 1 underwent ejaculation-preserving transurethral bipolar enucleation of prostate (ep-TUBEP) and Group 2 underwent ep-TUBRP. All patients were evaluated pre- and postoperatively using the maximum urinary flow rate (Qmax); post-void residual urine volume (PVR); International Prostate Symptom Score (IPSS); and the five-item version of the International Index of Erectile Function (IIEF-5), including two additional questions evaluating ejaculation and orgasm. All patients were followed-up at 1, 3, and 6 months. Results: Overall, 100, 98 and 97 patients were evaluated at 1, 3 and 6 months, respectively. All preoperative parameters such as age, prostate-specific antigen (PSA), prostate volume, Qmax, PVR, IPSS, and IIEF-5 were comparable between the two groups (all P>0.05). At the 1-month follow-up, antegrade ejaculation was preserved in 88 of 100 (88%) (45 patients in Group 1 and 43 in Group 2). In addition, there were significant improvements in Qmax [from a mean (SD) of 6.54 (1.72) mL/s to 15.38 (3.02) mL/s], PVR [from a mean (SD) of 94.4 (41.85) mL to 25.04 (32.72) mL], and IPSS [from a mean (SD) of 21.7 (6.6) to 11.72 (2.39)] compared with the preoperative measurements. Moreover, these improvements were maintained at the 3- and 6-month follow-up visits (all P<0.001). No serious adverse events were reported. Conclusion: Ejaculation-preserving transurethral bipolar prostatectomy seems safe and effective for preservation of antegrade ejaculation with either the resection or the enucleation technique