Laser therapy and other less invasive surgeries for benign prostatic hypertrophy (BPH) were developed because of concerns about the high rate of sexual dysfunction following transurethral resection of the prostate (TURP). Brookes and colleagues investigated the prevalence of self-reported sexual dysfunction in men who underwent laser surgery, TURP, and conservative (nonsurgical) management as part of a randomized trial of interventions for BPH.
The trial involved 340 men between 48 and 90 years of age who were seen for urologic disorders at three British teaching hospital clinics. Selected patients had uncomplicated lower urinary tract symptoms (an international prostate symptom score of at least 8) and a maximum urinary flow of less than 15 mL per second. Patients with limited life expectancy, previous prostatic surgery, evidence of carcinoma, very large prostate glands, neuropathic bladder function, or elevated creatinine levels were excluded from the study. Patients were randomly assigned to one of the three treatment strategies.
The 106 men assigned to conservative management received bladder training and advice but no active intervention. The surgical groups contained 117 men each. Seven and one-half months after treatment, the patients completed a standardized questionnaire about sexual function (International Continence Society ICSsex questionnaire), a seven-item prostatic symptom score scale, and a quality-of-life assessment.
Before surgery, 70 percent of patients reported erectile and ejaculatory dysfunction. At follow-up, erectile dysfunction was reported by 55 percent of the TURP group and 66 percent of the laser-surgery group. Pain on ejaculation was reduced from 17 to 2 percent following TURP but increased from 18 to 20 percent after laser surgery. Only one man (5 percent) in the TURP group reported new onset of erectile dysfunction, compared with five (20 percent) in the laser-surgery group.
The authors conclude that sexual dysfunction is common in men undergoing treatment for lower urinary tract obstruction, but that laser therapy does not show an advantage over TURP. Erectile dysfunction and pain on ejaculation were significantly benefitted by TURP compared with laser procedures.