Impact of Plasmakinetic Enucleation of the Prostate (PKEP) on Sexual Function: Results of a Prospective Trial

Abstract

Recent data have shown that plasmakinetic enucleation of the prostate (PKEP) is a novel and effective procedure for symptomatic benign prostatic hyperplasia (BPH); however, data on patient sexual function after PKEP remain scarce. This study aims to evaluate the impact of PKEP on sexual function in men with lower urinary tract symptoms because of BPH. One hundred eighty-six consecutive patients who underwent the PKEP procedure were prospectively enrolled in this study. The International Index of Erectile Function (IIEF-15) and the International Prostate Symptom Score with quality of life scores were completed and compared preoperatively and at 1, 3, 6, and 12 months postoperatively. At each follow-up visit, maximum urinary flow rates, transrectal ultrasound-assessed prostate volume, postvoid residual urine volume, and serum prostate-specific antigen level were also measured and compared with the baseline. The IIEF global score and its five domains scores were evaluated for each patient, and the Friedman test or chi-square test was used to identify changes from the baseline. There was a slight and nonsignificant increase in the IIEF global score and four of its five domains scores (i.e., erectile function, intercourse satisfaction, sexual desire, and overall satisfaction) at each postoperative assessment (P > 0.05 for all). However, a statistically significant reduction was observed in the orgasmic function domain score of IIEF at 3 months (P = 0.016), 6 months (P < 0.001), and 12 months (P < 0.001), respectively, along with the corresponding retrograde ejaculation rates of 48.7%, 49.4%, and 48.8%. PKEP has no negative influence on the quality of erections measured by the self-administered IIEF questionnaire, but it significantly lowers the orgasmic function domain score, reflecting probably postoperative retrograde ejaculation. These findings are important in preoperative counseling of the patients undergoing PKEP for symptomatic BPH.