Better erectile function is seen at 24 months with prostatic urethral lift

Prostatic urethral lift ranks highly for postoperative erectile function, up to 24 months, compared with other benign prostatic obstruction treatment options, including monopolar transurethral resection (mTURP).

But longer-term follow up after benign prostatic obstruction surgery reveals the interventions have similar impacts on sexual function, according to a meta-analysis published in European Urology.¹

Investigators analyzed 48 papers, including 33 randomized controlled trials of more than 5,100 patients and 16 benign prostatic obstruction interventions. The primary outcome was postoperative International Index of Erectile Function-5 (IIEF-5) score at 10 time points up to 72 months, according to the paper. Ejaculatory function was not assessed.

“This study suggests that there is little difference in erectile dysfunction between the various treatments over 60-month follow-up,” according to study author Peter Gilling, MD, a professor of surgery at the University of Auckland, Tauranga, New Zealand. “Comparative prostatic urethral lift data was unavailable beyond 24 months and was not studied in prostates greater than 60 g, but early results for the [International Index of Erectile Function-5] score were promising.”

Although mTURP has been the standard benign prostatic obstruction surgical intervention, newer treatment options include tissue-sparing prostatic urethral lift, prostatic arterial embolization, photo-selection vaporization, holmium laser enucleation, Aquablation, and others.

The possibility of worsening erectile dysfunction remains an important consideration with any prostatic intervention, and it is unclear whether successful surgery might actually improve sexual function, according to the authors.

The authors found:

• Prostatic urethral lift consistently ranked higher and at 24 months had a significantly higher International Index of Erectile Function-5 score than mTURP.

• Prostatic urethral lift ranked significantly higher than laparoscopic simple prostatectomy, open prostatectomy, prostatic arterial embolization and bipolar TURP, or bTURP, at 12 months.

• At 24 months, prostatic urethral lift ranked significantly higher than Aquablation, holmium laser enucleation, photo-selective vaporization, laparoscopic simple prostatectomy, and open prostatectomy.

Prostatic urethral lift data were not available beyond 2 years. And the intervention’s effect in larger prostates could not be assessed because prostate urethral lift was not studied in in men with a mean prostate volume of more than 60 mL.

“Considering the limited number of [prostatic urethral lift] studies and therefore direct evidence, further trials are required before robust recommendations can be made,” the authors wrote.

The novel radiological intervention prostatic arterial embolization has performed inconsistently in studies, ranking second at 3 months and last at 12 months in this paper. So, it is important that future randomized controlled trials focus on sexual function after prostatic arterial embolization, according to the authors

And there is only 1 trial in this meta-analysis looking at Aquablation, so more research and longer follow up is needed to better characterize its impact, the authors write.

The lack of data on sexual function measures postbenign prostatic obstruction intervention limits these findings, according to the authors.

“Despite detrimental effects on quality of life, many trials on [benign prostatic obstruction] treatments omit research on erectile function, so this needs further study in [randomized controlled trials], particularly for newer interventions,” they wrote.

Gilling, whose go-to intervention for treating benign prostatic obstruction is holmium laser enucleation, said findings from this work, alone, are unlikely to change urology practice.

“mTURP performed well in comparison to other treatments and is known to out-perform many of these treatments for clinical efficacy,” Gilling said. “The prostatic urethral lift data cannot be readily explained, and further high-quality comparative data would be useful to confirm the findings.”

Reference

1. Light A, Jabarkhyl D, Gilling P, et al. Erectile function following surgery for benign prostatic obstruction: a systematic review and network meta-analysis of randomised controlled trials. Eur Urol. 2021;80(2):174-187. doi:10.1016/j.eururo.2021.04.012