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Minerva Urologica e Nefrologica 2019 October;71(5):427-34

DOI: 10.23736/S0393-2249.19.03588-4


language: English

Anterograde ejaculation preservation after endoscopic treatments in patients with bladder outlet obstruction: systematic review and pooled-analysis of randomized clinical trials

Giovanni E. CACCIAMANI 1 , Frederico CUHNA 1, Alessandro TAFURI 1, 2, Aliasger SHAKIR 1, Andrea COCCI 3, Karanvir GILL 1, Juan GÓMEZ RIVAS 4, Aurus DOURADO 5, Domenico VENEZIANO 6, Zhamshid OKHUNOV 7, Paolo CAPOGROSSO 8, Pierre A. HUEBER 1, Marteen ALBERSEEN 9, Andre ABREU 1, Filippo MIGLIORINI 2, Cristian FIORI 10, Antonio B. PORCARO 2, Francesco PORPIGLIA 10, Mihir DESAI 1, Giorgio I. RUSSO 11, on behalf of European Association of Urology Young Academic Urologists (EAU-YAU) Urotechnology and Men’s Health working groups

1 USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA; 2 Department of Urology, University of Verona, Verona, Italy; 3 Department of Urology, Careggi Hospital, University of Florence, Florence, Italy; 4 Department of Urology, La Paz Hospital, Madrid, Spain; 5 Department of Urology, São Marcos Hospital, Piauí, Brazil; 6 Department of Urology and Renal Transplantation, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy; 7 Department of Urology, University of California, Irvine, CA, USA; 8 Department of Urology, San Raffaele Hospital, Milan, Italy; 9 Department of Urology and Pediatric Urology, Medicine University Mainz, Mainz, Germany; 10 Department of Urology, San Luigi Hospital, University of Turin, Turin, Italy; 11 Department of Urology, University of Catania, Catania, Italy

INTRODUCTION: Despite the high rate of resolution, ejaculatory dysfunction still is the most common side effect related to surgical treatment of bladder outlet obstruction (BOO). The aim of the present systematic review was to compare several technological treatment modalities for the management of lower urinary tract symptoms/BOO in terms of functional and sexual outcomes.
EVIDENCE ACQUISITION: All English language randomized controlled trials assessing the impact of different endoscopic treatments for BOO were evaluated. We followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement to evaluate PubMed®, Scopus®, and Web of Science™ databases (up to June 2019).
EVIDENCE SYNTHESIS: Our electronic search identified a total of 2221 papers in PubMed, Scopus, and Web of Science. Of these, 142 publications were identified for detailed review, which yielded 21 included in the present systematic review. All groups appeared similar with regards to preoperative IPSS/AUA Score, Qmax, and prostate volume (cc). Patients undergoing endoscopic treatments using ThuLEP, Greenlight or Prostate Artery Embolization techniques had lower-but not statistically significant- relative risk (RR) of retrograde ejaculation compared with conventional transurethral resection of the prostate (TURP) (RR: 0.90; P=0.35; RR: 0.71; P=0.1; RR0.73; P=0.11). Efficacy of those techniques was equal to TURP.
CONCLUSIONS: Data reporting anterograde ejaculation preservation after endoscopic treatment in patients with benign prostatic enlargement are sparse and heterogeneous. Pooled analyses suggest that new technological alternatives to conventional TURP might improve sexual outcomes, especially for non-ablative treatments.

KEY WORDS: Ejaculation; Meta-analysis; Urinary bladder neck obstruction; Endoscopy

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