This article poses an interesting question: whilst we know there is an association with HoLEP and ejaculatory dysfunction (BAUS quotes a 90% risk for retrograde ejaculation), is this risk dependent on surgeon experience and their learning curve with HoLEP? This paper found no evidence of this! In a study based in Madrid, Spain with 254 patients undergoing HoLEP by the same surgeon, the anejaculation rate persisted above 93.2% at follow up, irrespective of surgeon experience. Equally, erectile dysfunction was measured with the Sexual Health Inventory for Men (SHIM) questionnaire (also known as IIEF-5) pre-operatively and at 1, 3, 6 and 12 months post-operatively – whilst taking an initial and understandable hit at one month post op, SHIM scores returned to preoperative ranges, the average being mild-to-moderate erectile dysfunction. Although these results are fairly consistent with what we already know, the authors argue these results are useful for counselling. Whilst they can be hopeful their erectile function stays at their baseline, if anejaculation is a concern for them, HoLEP might not be the best BOO surgical option (the authors point to Aquablation and Rezum for more favourable side profiles here). There are a few limitations with this study to note: first, this is a single surgeon’s experience who has used all three popularised techniques (trilobe, bilobe and enbloc) for their procedures with no data on how this may or may not have made a difference. An unknown proportion of patients were using an alpha blocker or a phosphodiesterase type 5 inhibitor pre-operatively, both of which can potentially confound the post-operative results. The paper itself admits it cannot establish causal relationships between HoLEP and sexual function. If you are on the HoLEP learning curve there’s one thing to take away from this paper: sexual function data is not a great way of assessing your progress!
Practice makes perfect – but does the HoLEP learning curve affect sexual function?
Reviewed by Stephanie D’Costa
Erectile and ejaculatory outcomes after HoLEP: A longitudinal analysis during the learning curve.
CONTRIBUTOR
Stephanie D'Costa
Barking, Havering and Redbridge University NHS Trust; Academic Clinical Fellow, Queen Mary University of London, UK.
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