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Manfredi C, García-Gómez B, Arcaniolo D, García-Rojo E, Crocerossa F, Autorino R, Gratzke C, De Sio M, Romero-Otero J. Impact of Surgery for Benign Prostatic Hyperplasia on Sexual Function: A Systematic Review and Meta-analysis of Erectile Function and Ejaculatory Function. Eur Urol Focus 2022; 8:1711-1732. [PMID: 35803852 DOI: 10.1016/j.euf.2022.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/17/2022] [Indexed: 01/25/2023]
Abstract
CONTEXT Several sexual side effects, including erectile, ejaculatory, and orgasmic dysfunction, were reported with the majority of surgical procedures for benign prostatic obstruction (BPO). OBJECTIVE To systematically review current evidence regarding the impact of benign prostatic hyperplasia (BPH) surgery on sexual function. EVIDENCE ACQUISITION A comprehensive bibliographic search on the MEDLINE, Cochrane Library, Embase, Web of Science, and Google Scholar databases was conducted in July 2021. The population, intervention, comparator, and outcome (PICO) model was used to define study eligibility. Studies were Included if they assessed patients with BPO and related lower urinary tract symptoms (P) undergoing BPH surgery (I) with or without a comparison between surgical treatments (C) evaluating the impact on sexual function (O). Retrospective and prospective primary studies were included. A pooled analysis was conducted on studies including the postoperative assessment of International Index of Erectile Function (IIEF)-5, Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD; Function and/or Bother), or retrograde ejaculation (RE) rate (PROSPERO database ID: CRD42020177907). EVIDENCE SYNTHESIS A total of 151 studies investigating 20 531 patients were included. Forty-eight randomized controlled trials evaluating 5045 individuals were eligible for the meta-analysis. In most studies (122, 80.8%), only erectile and/or ejaculatory function was evaluated. A substantial number of articles (67, 44.4%) also used nonvalidated tools to evaluate erectile and/or ejaculatory function. The pooled analysis showed no statistically significant changes in IIEF-5 score compared with baseline for the transurethral resection of the prostate (TURP; weighted mean difference [WMD] 0.76 pts; 95% confidence interval [CI] -0.1, 1.62; p = 0.08), laser procedure (WMD 0.33 pts; 95% CI -0.1, 0.77; p = 0.13), and minimally invasive treatment (WMD -1.37 pts; 95% CI -3.19, 0.44; p = 0.14) groups. A statistically significantly higher rate of RE was found after TURP (risk ratio [RR] 13.31; 95% CI 8.37, 21.17; p < 0.00001), other electrosurgical procedures (RR 34.77; 95% CI 10.58, 127.82; p < 0.00001), and the entire laser group (RR 17.37; 95% CI 5.93, 50.81; p < 0.00001). No statistically significant increase in RE rate was described after most of the minimally invasive procedures (p > 0.05). The pooled analysis of MSHQ-EjD scores was possible only for prostatic urethral lift, showing no statistically significant difference between baseline and post-treatment MSHQ-EjD Function scores (WMD -0.80 pts; 95% CI -2.41, 0.81; p = 0.33), but postoperative MSHQ-EjD Bother scores were significantly higher (WMD 0.76 pts; 95% CI 0.22, 1.30; p = 0.006). CONCLUSIONS Erectile function appears to be unaffected by most surgical procedures for BPO. RE is a very common adverse event of BPH surgery, although emerging minimally invasive surgical procedures could be associated with a lower risk. PATIENT SUMMARY Benign prostatic hyperplasia surgery can have an impact on sexual function, mainly involving ejaculatory function.
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Affiliation(s)
- Celeste Manfredi
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Borja García-Gómez
- Department of Urology, Hospital Universitario 12 Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain; ROC Clinic, Madrid, Spain
| | - Davide Arcaniolo
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Esther García-Rojo
- Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain; ROC Clinic, Madrid, Spain
| | - Fabio Crocerossa
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Riccardo Autorino
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | - Christian Gratzke
- Department of Urology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Marco De Sio
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Javier Romero-Otero
- Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain; ROC Clinic, Madrid, Spain.
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Bhojani N, Yafi FA, Misrai V, Rijo E, Chughtai B, Zorn KC, Elterman D. Review of Sexual Preservation After Novel Benign Prostatic Hyperplasia Surgical Treatment Modalities From Food and Drug Administration Clinical Trials. Sex Med Rev 2020; 9:169-173. [PMID: 33309271 DOI: 10.1016/j.sxmr.2020.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Traditional benign prostatic hyperplasia treatment options, such as transurethral resection of the prostate and laser, have focused on addressing urinary symptoms for men; however, these options are associated with a high risk of sexual dysfunction. OBJECTIVE The objective of this study was to assess newer technologies (Aquablation therapy, UroLift, and Rezum) for the treatment of benign prostatic hyperplasia and the impact of preserving sexual function compared with transurethral resection of the prostate. METHODS A comprehensive review of Food and Drug Administration randomized studies from each of the technologies was carried out. A comparison of 3-year outcomes for International Index of Erectile Function-5 and Male Sexual Health Questionnaire Ejaculatory Function domain short form was analyzed. RESULTS Aquablation and prostatic urethral lift were the only therapies to show permanent sexual function preservation in both Male Sexual Health Questionnaire Ejaculatory Function domain short form (ejaculatory function) and International Index of Erectile Function-5 (erectile function) at 3 years after treatment. CONCLUSION For prostates less than 80 cc, Aquablation and prostatic urethral lift were able to demonstrate permanent sexual function preservation in both Male Sexual Health Questionnaire Ejaculatory Function domain short form (ejaculatory function) and International Index of Erectile Function-5 (erectile function) at 3 years after treatment. Bhojani N, Yafi FA, Misrai V, et al. Review of Sexual Preservation After Novel Benign Prostatic Hyperplasia Surgical Treatment Modalities From Food and Drug Administration Clinical Trials. Sex Med Rev 2021;9:169-173.
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Affiliation(s)
- Naeem Bhojani
- Division of Urology, Centre hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, QC, Canada.
| | - Faysal A Yafi
- Department of Urology, University of California Irvine, Irvine, CA, USA
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Enrique Rijo
- Department of Urology, Hospital Quiron Salud, Barcelona, Spain
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York Presbyterian, New York, USA
| | - Kevin C Zorn
- Division of Urology, Centre hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, QC, Canada
| | - Dean Elterman
- Division of Urology, University Health Network (UHN), University of Toronto, Toronto, ON, Canada
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El Shorbagy G, El Ghoneimy M, El Feel A, Abdel Rassoul M, Kassem A, Hussein H, El Gammal M. Comparison of impact of monopolar versus bipolar resection of the prostate on erectile function in patients with benign hyperplasia of the prostate. AFRICAN JOURNAL OF UROLOGY 2018. [DOI: 10.1016/j.afju.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Influence of Transurethral Resection of Bladder Cancer on Sexual Function, Anxiety, and Depression. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1116:37-50. [PMID: 30242788 DOI: 10.1007/5584_2018_264] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The standard of care in non-muscle invasive bladder cancer consists of transurethral tumor resection. The aim of this study was to evaluate the influence of transurethral resection of bladder tumor (TURB) on the patients' self-reported depression, anxiety, sexual satisfaction, and erectile dysfunction. Psychological condition of 252 male patients who underwent TURB was prospectively evaluated. The Hospital Anxiety and Depression Scale (HADS), simplified International Index of Erectile Function (IIEF-5), and Sexual Satisfaction Questionnaires (SSQ) were administered to patients before and 10 days after tumor resection. We found that primary anxiety, depression, and erectile dysfunction were all worse in cancer patients than those in the general population, and all further worsened after tumor resection. The post-resection worsening was influenced by the operation and catheterization time, complications, and the tumor characteristics. Taxonomical analysis shows that the greatest risk of depression aggravation concerned patients who were younger, had a higher body mass index, and a medium-sized tumor. We conclude that transurethral resection of non-muscle invasive bladder cancer may adversely affect sexual function, anxiety, and depression. Patients should be informed about potential complications to prevent the abandonment of a follow-up. The findings of this study stress the role of personalized medicine pursued by a multidisciplinary medical team.
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Wani SA, Amin A. Intestinal helminth infections among children of district Shopian of Kashmir Valley, India. J Parasit Dis 2016; 40:1422-1425. [PMID: 27876961 DOI: 10.1007/s12639-015-0705-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/28/2015] [Indexed: 11/29/2022] Open
Abstract
Intestinal helminth infections are amongst the most common infections worldwide. Studies in other districts of Kashmir Valley revealed a high prevalence of intestinal helminth infections among the children. The objectives of the current study were to determine the prevalence of intestinal helminth infections among children of Shopian district and to identify associated socio-demographic and environmental actors, behavioral habits and also related complaints. Stool samples were collected from 352 children and a questionnaire was filled for each case. The samples were processed using both simple smear and zinc sulphate concentration methods, and then microscopically examined for intestinal helminths. Of the 352 children surveyed, 75.28 % had 1, or more, helminth parasites. Prevalence of Ascaris lumbricoides was highest (71.8 %), followed by Trichuris trichiura (26.4 %), Enterobius vermicularis (13.9 %) and Taenia saginata (5.3 %). Conditions most frequently associated with infection included the age group, water source, boiled or unboiled water, defecation site, personal hygiene, and the extent of maternal education. The study shows a relatively high prevalence of intestinal helminths and suggests an imperative for the implementation of control measures.
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Affiliation(s)
| | - Ayshia Amin
- P. G. Department of Zoology, The University of Kashmir, Srinagar, India
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Zhao Z, Ma W, Xuan X, Ou L, Liang Y, Zeng G. Impact of Plasmakinetic Enucleation of the Prostate (PKEP) on Sexual Function: Results of a Prospective Trial. J Sex Med 2012; 9:1473-81. [DOI: 10.1111/j.1743-6109.2011.02522.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jaidane M, Arfa NB, Hmida W, Hidoussi A, Slama A, Sorba NB, Mosbah F. Effect of transurethral resection of the prostate on erectile function: a prospective comparative study. Int J Impot Res 2009; 22:146-51. [PMID: 19940854 DOI: 10.1038/ijir.2009.56] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The effect of transurethral resection of the prostate (TURP) on erectile function is still controversial, and available evidence is conflicting. One of the possible mechanisms of post-TURP erectile dysfunction (ED) is direct thermal injury to the erectile nerves. The aim of this study was to investigate the effect of TURP on erectile function. Fifty patients undergoing TURP for obstructive benign prostatic hyperplasia (HBP) were prospectively included in the study, and 50 age-matched patients undergoing transurethral resection of the superficial bladder tumor were also prospectively included as a control group. All patients completed the international index of erectile function (IIEF-15), the international prostatic symptom score (IPSS) and the Hospital Anxiety and Depression Scale at inclusion in the study and then at the 3- and 6-month follow-up evaluation. Capsular perforations during TURP were prospectively reported by the operating surgeon. There was a significant improvement of erectile function in the TURP group despite the onset of ejaculation disorders in 70% of the patients. Improvement of erectile function was also found in the subgroup of patients with capsular perforation during TURP. Comparison with the control group showed that at preoperative evaluation, patients in the TURP group had more severe urinary symptoms and worse erectile function than did those of the control group. At the postoperative period, the IPSS score became comparable in the two groups, with major improvement of erectile function in the TURP group. We concluded that TURP improved erectile function in HBP patients with severe urinary symptoms. This improvement of erectile function was observed even in case of capsular perforation.
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Affiliation(s)
- M Jaidane
- Department of Urology, Sahloul University Hospital, Sousse, Tunisia.
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Wani SA, Ahmad F, Zargar SA, Ahmad Z, Ahmad P, Tak H. Prevalence of intestinal parasites and associated risk factors among schoolchildren in Srinagar City, Kashmir, India. J Parasitol 2008; 93:1541-3. [PMID: 18314713 DOI: 10.1645/ge-1255.1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Surveys on the prevalence of various intestinal parasitic infections in different geographic regions is a prerequisite for developing appropriate control strategies. The aim of the present study was to determine the prevalence of intestinal parasitic infections in schoolchildren enrolled in various schools in Srinagar City, Kashmir, India, and to assess epidemiological factors associated with the extent of endemic disease. Stool samples were collected from 514 students enrolled in 4 middle schools. The samples were processed with the use of both simple smear and zinc sulphate concentration methods, and then microscopically examined for intestinal parasites. Of the 514 students surveyed, 46.7% had 1, or more, parasites. Prevalence of Ascaris lumbricoides was highest (28.4%), followed by Giardia lamblia (7.2%), Trichuris trichiura (4.9%), and Taenia saginata (3.7%). Conditions most frequently associated with infection included the water source, defecation site, personal hygiene, and the extent of maternal education. The study shows a relatively high prevalence of intestinal parasites and suggests an imperative for the implementation of control measures.
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