Objective
To evaluate perioperative outcomes related to sexual and urinary function in patients
who underwent a holmium laser enucleation of the prostate (HoLEP) with selective laser
enucleation of the median lobe.
Materials and Methods
We retrospectively reviewed the first 450 HoLEP cases by a single surgeon from April
2019 to March 2022. Fifty-five patients with intravesical-prostatic protrusion or
high bladder neck without obstructing lateral lobes underwent selective enucleation
of the median lobe of the prostate. Patients were asked to comment on whether they
had retrograde ejaculation during their follow-up appointment. Urinary function was
assessed using the American Urological Association Symptom Score and subjective evaluation
of urinary incontinence.
Results
Median age of the cohort was 65 years (range: 44-91). Compared to preoperative, there
was significant improvement in mean postoperative American Urological Association
Symptom Score (22.5 vs 6.9, P < .001), mean postoperative quality of life scores (4 vs 1.2, P < .001), and mean postoperative post void residual volumes (244.1 vs 69.3 cc, P < .001). No patients reported stress urinary incontinence. Of the 55 patients who
underwent selective enucleation of the median lobe, 40 were sexually active. Of those
men, 35 reported normal ejaculation, 3 had retrograde ejaculation that was unchanged
from pre-op, and 2 had new ejaculatory dysfunction.
Conclusion
In this case series of selective laser enucleation of the median lobe, urinary function
significantly improved in short-term follow-up with preservation of ejaculation in
approximately 90% of men.
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Article info
Publication history
Published online: January 13, 2023
Accepted:
December 28,
2022
Received:
August 6,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
