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Volume 12, Issue 4 (July 2010) 12, 500–508; 10.1038/aja.2010.33

The impact of minimally invasive surgeries for the treatment of symptomatic benign prostatic hyperplasia on male sexual function: a systematic review

Ryan W. Frieben, Hao-Cheng Lin, Peter P. Hinh, Francesco Berardinelli, Steven E. Canfield and Run Wang

1 Division of Urology, University of Texas Medical School at Houston, Houston, TX 77030, USA
2 Department of Urology, Affiliated Drum Tower Hospital, Nanjing University School of Medicine, Nanjing 210008, China
3 Division of Urology, Department of Medicine and Aging Sciences, “G.d'Annunzio” University, Chieti, Italy
4 Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA

Correspondence: Dr Run Wang,run.wang@uth.tmc.edu

Received: 26 February 2010 Revised: 8 April 2010 Accepted: 8 April 2010 Published online: 17 May 2010


A systematic review of randomized controlled trials and cohort studies was conducted to evaluate data for the effects of minimally invasive procedures for treatment of symptomatic benign prostatic hyperplasia (BPH) on male sexual function. The studies searched were trials that enrolled men with symptomatic BPH who were treated with laser surgeries, transurethral microwave therapy (TUMT), transurethral needle ablation of the prostate (TUNA), transurethral ethanol ablation of the prostate (TEAP) and high-intensity frequency ultrasound (HIFU), in comparison with traditional transurethral resection of the prostate (TURP) or sham operations. A total of 72 studies were identified, of which 33 met the inclusion criteria. Of the 33 studies, 21 were concerned with laser surgeries, six with TUMT, four with TUNA and two with TEAP containing information regarding male sexual function. No study is available regarding the effect of HIFU for BPH on male sexual function. Our analysis shows that minimally invasive surgeries for BPH have comparable effects to those of TURP on male erectile function. Collectively, less than 15.4% or 15.2% of patients will have either decrease or increase, respectively, of erectile function after laser procedures, TUMT and TUNA. As observed with TURP, a high incidence of ejaculatory dysfunction (EjD) is common after treatment of BPH with holmium, potassium-titanyl-phosphate and thulium laser therapies (> 33.6%). TUMT, TUNA and neodymium:yttrium aluminum garnet visual laser ablation or interstitial laser coagulation for BPH has less incidence of EjD, but these procedures are considered less effective for BPH treatment when compared with TURP.

Keywords: benign prostatic hyperplasia; ejaculatory dysfunction; erectile dysfunction; minimally invasive surgery; sexual function; transurethral resection of the prostate

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