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BACKGROUND: Laser Anatomical Endoscopic Enucleation of the Prostate (LAEEP) techniques offer a promising solution for patients seeking to alleviate urinary symptoms while preserving sexual function. The ejaculation preservation approach has been shown to achieve an impressive 90% success rate in maintaining antegrade ejaculation. PURPOSE: To explore the effect of the ejaculatory preservation HoLEP technique on postoperative continence and ejaculation. PATIENTS AND METHODS: We conducted a prospective randomized study adhering to CONSORT guidelines. Patients with prostate sizes between 40 and 80 gm, IPSS scores > 20, Qmax 22 were eligible for inclusion. A total of 43 patients were randomized into two groups: Group 1 (n = 22) underwent HoLEP, while Group 2 (n = 21) underwent EP HoLEP. We assessed functional outcomes and ejaculatory dysfunction at baseline and 1-, 3-, and 6- month. The study period was from October 2022 to March 2024. RESULTS: Data from 40 patients were analyzed. Functional outcomes showed significant improvement in Group 1, with IPSS (median 12.5, P < 0.006) and Qmax (median 15, P < 0.04) at 3-month. ICIQ-UI SF scores showed a significant difference in the incontinence episodes (domain Q3), which were lower (P < 0.023) in Group 2 compared to Group 1 during the 1-month visit. MSHQ-EjD-SF scores were significantly higher in Group 2 at both 3- and 6- month (P < 0.01 and P < 0.02, respectively). IIEF-5 scores showed no significant difference between both groups during the study period. CONCLUSION: Implementing the ejaculation preservation technique during HoLEP appears to improve early postoperative continence and preserve ejaculation.
Eliwa et al. (Mon,) studied this question.