(036) Predictors of Treatment Regret After Laser Enucleation of the Prostate for Benign Prostatic Obstruction

Introduction Anatomical endoscopic laser enucleation of the prostate (AEEP) is recognized as a first-line surgical treatment for benign prostatic obstruction (BPO), however the loss of antegrade ejaculation is a frequent condition post-operatively. Objective The aim of this study was to analyze data on possible regret and the factors that might influence patient's dissatisfaction. Methods We analyzed data from a perspectively maintained database, including 202 consecutive patients treated in the same institution, either with holmium or thulium laser AEEP for BPO. Preoperative and perioperative clinical and functional data, including the International Prostate Symptom Score (IPSS) and Sexual Encounter Profile (SEP) 2-3 questionnaire, were collected. All patients were reassessed at regular follow-up visits after surgery. Treatment regret was evaluated at 12 months postoperatively with a dedicated questionnaire during a routinary urologic check-up. Logistic regression analysis was used to identify preoperative and postoperative predictors of regret. Results Overall, 75 (37%) and 127 (63%) patients were treated with HoLEP and ThuLEP, respectively. Median (IQR) age was 71 (65, 75) years with a body mass index (BMI) of 22.4 (20.6, 25.8). Patients had a high median prostate volume [94 (65, 113) ml] with a median PSA of 3.3 (1.4, 6.9) ng/mL and an IPSS of 20 (11, 25). A total of 118 (58%) patients were sexually active at baseline with normal erectile function according to SEP 2-3 questions. After surgery, dissatisfaction with the loss of antegrade ejaculation was reported by 24% (N=49) of the patients overall, with 46% (N=92) of them reporting being sexually active. At logistic regression, younger age (OR 1.13; 95% CI 1.06–1.20; p<0.001) and being sexually active preoperatively (OR 0.39; 95% CI 0.17–0.89; p=0.025) were identified as independent predictors of treatment regret. The type of laser enucleation and postoperative complications were not associated with treatment regret (all p>0.05). Conclusions Young and sexually active patients treated with AEEP are at risk of treatment regret due to the loss of ejaculation. Preoperative counseling should consider ejaculation-sparing techniques for selected patients to more effectively tailor patient management. Disclosure No