Re: Do Patients Have to Choose between Ejaculation and Miction? A Systematic Review about Ejaculation Preservation Technics for Benign Prostatic Obstruction Surgical Treatment
Abstract
available at http://www.ncbi.nlm.nih.gov/pubmed/29967947 Editorial Comment: The evolution and frankly marketing of minimally invasive and alternative surgical procedures to treat lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia have been quite interesting. While we accept that transurethral prostatectomy is effective in alleviating symptoms, the downside consequence of sexual dysfunction has been trumpeted over the last decade. In part, this phenomenon is secondary to the public becoming more informed and unfortunately more misinformed about erectile dysfunction in the age of phosphodiesterase type 5 inhibitors, and the ensuing development of metrics for erectile dysfunction and ejaculatory dysfunction (EjD). This now seems to be the Holy Grail: improve LUTS to some degree but preserve sexual function. Do patients care? Not surprisingly, it depends on who you ask, ie age, degree of sexual function and magnitude of LUTS all are factors in shared decision making. In this study the authors analyzed the available data to ascertain if there are any techniques that are more or less likely to result in EjD. They found the lowest rates of EjD with prostatic urethral implants and water ablation of the prostate. Is this a surprise? What has been notable are the various manufacturers and marketers of minimally invasive and surgical alternatives, such as lasers and water ablation of the prostate, who are doing cartwheels in endeavoring to have the lowest…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 10,054 participants or records.
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