(164) Comparative Risk of Erectile and Ejaculatory Dysfunction Following UroLift vs. Optilume in Men Undergoing Minimally Invasive BPH Therapy: A Propensity-Matched Cohort Study of 12-Month Outcomes

Introduction Recently, several minimally invasive surgical therapies (MISTs) have become popular options for certain men with benign prostatic hyperplasia (BPH). Two popular MIST therapies include Optilume, a paclitaxel-coated urethral balloon dilation treatment, and UroLift implants that mechanically widen the prostatic urethral lumen. However, data examining sexual side effects of these treatments, especially direct comparisons, is scarce. Objective To compare outcomes of erectile dysfunction (ED) and ejaculatory dysfunction (EJD) following UroLift versus Optilume using a large real-world dataset with 12-month follow-up. Methods We conducted a retrospective cohort study using the TriNetX research network. Men undergoing UroLift (CPT 52441) or Optilume (CPT 52284) for BPH (ICD-10 N40) were identified. Patients with prior ED (N52) or EJD (N53.1) diagnoses were excluded. Before matching, the UroLift and Optilume cohorts included 8,630 and 1,214 patients, respectively. Propensity score matching (1:1) based on age, race, BMI, hypertension, diabetes, hyperlipidemia, and testicular hypofunction yielded 1,169 matched patients per group (2,338 total). Median follow-up was 365 days (IQR: 365–365) for UroLift and 127 days (IQR: 15.5–238.5) for Optilume. Primary outcomes were new-onset ED and EJD within 1-year post-procedure. Risk differences, relative and odds ratios, and Kaplan-Meier survival analyses were used. Results Among the 1,169 matched patients in each group, 827 UroLift and 898 Optilume patients remained after excluding those with baseline ED. New-onset ED occurred in 6.76% of UroLift patients and 2.78% of Optilume patients. Optilume was associated with significantly lower risk (RR: 0.412, 95% CI 0.259–0.655; ARR: 3.97%; p = 0.0001). However, 12-month ED-free survival did not significantly differ (92.25% UroLift vs. 93.46% Optilume; log-rank p = 0.2730). Cox regression yielded a hazard ratio of 0.764 (95% CI 0.472–1.238; p = 0.3487). Among 1,133/1169 UroLift and 1,157/1169 Optilume patients without baseline EJD, new-onset EJD occurred in ≤10 patients per group. The risk difference was –0.018% (95% CI –0.781%, 0.744%; p = 0.9625), with risk and odds ratios of 0.979 (95% CI 0.409–2.344) and 0.979 (95% CI 0.406–2.361), respectively. One-year EJD-free survival was 99.22% for UroLift vs. 99.86% for Optilume (log-rank p = 0.0848; HR: 0.194, 95% CI 0.024–1.553). Conclusions Both UroLift and Optilume appear to have favorable sexual function safety profiles at 12 months. While absolute ED incidence was lower with Optilume, Kaplan-Meier analysis revealed no significant difference in ED-free survival between groups. EJD risk was low and equivalent. These findings support the safety of MISTs for men prioritizing sexual preservation, though comprehensive preoperative counseling may be especially important when considering UroLift in patients at elevated risk for ED. Disclosure No