Ejaculation-sparing enucleation of the prostate with thulium. Yag laser (ES-ThuLEP) versus thulium fiber laser (ES-ThuFLEP). Outcomes on sexual function

Purpose: To compare the effect on sexual function of ejaculation-sparing enucleation of the prostate using Thulium: YAG laser (ES-ThuLEP) versus continuous-wave Thulium Fiber Laser (ES-ThuFLEP). Methods: 112 patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia who wished to preserve ejaculation were treated. 58 patients underwent ES-ThuLEP (Group A) using the Cyber TM generator. 54 patients underwent ES-ThuFLEP (Group B) using the Fiber Dust generator. Sexual function was evaluated through the International Index of Erectile Function 5 (IIEF-5) score, the four-item Male Sexual Health Questionnaire (MSHQ-EjD), personal satisfaction and the occurrence of haemospermia and painful ejaculation 3 and 6 months after surgery. Results: Mean age of patients was 65.8 years in Group A and 66.7 years in Group B. Groups were comparable according to preoperative features. Mean preoperative IIEF-5 score was 18.8 in Group A and 17.9 in Group B (p = 0.14). In all cases an ejaculation-sparing procedure was performed sparing the tissue around the veru montanum and near the prostate apex. Three months after surgery mean IIEF-5 score was 19.3 in Group A and 18.0 in Group B (p = 0.12). Six months after surgery mean IIEF-5 score was 17.8 in Group A and 18.1 in Group B (p = 0.09). No significant differences were observed according to anterograde ejaculation (81.0% vs. 81.5%, p = 0.07), subjective satisfaction (72.4% vs. 74.1%, p = 0.10), painful ejaculation (10.3% vs. 11.1%, p = 0.14) and haemosparmia rate (12.1% vs. 14.8%, p = 0.08). Ejaculation and satisfaction rate were significantly higher with prostates ≥ 80 ml in both groups. Conclusion: Ejaculation-sparing enucleation of the prostate effectively preserved sexual function in the majority of patients, with high rate of anterograde ejaculation and subjective satisfaction, low rates of painful ejaculation and haemospermia and no significant differences between Thulium: YAG and Thulium Fiber Laser. Preservation of ejaculation and personal satisfaction were significantly higher with prostates ≥ 80 ml compared to smaller ones.