Comparison of Different Processing Techniques Prostate Adenoma:

The majority ofbenign prostatic hyperplasia (BPH) associated with "lower urinary tract symptoms" present complications of urinary and sexual function, particularly in ejaculation and erection.

The quality of life of BPH patients is significantly affected by these treatments, hence the need for an optimal technique with no repercussions on sexual function.

An article by Wong and colleagues, published in 2020, carries out a comparative study between the various techniques for treating BPH and prostatic artery embolization, and highlights the consequences of these treatments on sexual function.

Below we present some of these treatments and their potential side effects:

Transurethral resection of the prostate (TURP) is has until now been considered the gold standard for the treatment of BPH. It consists of cutting away excess prostate tissue using an endoscopic resector inserted at the urethra. Despite its effectiveness in reducing prostate size, this technique resulted in retrograde ejaculation* in 70% of patients treated, and anejaculation* in 52% of cases.

Photovaporization and Holmium laser enucleation,  are techniques that use lasers to remove the prostate gland (prostatectomy).

Side effects of these techniques include absence of ejaculation or retrograde ejaculation in 30 to 77% of cases; painful ejaculation in 3.3 to 5.4 % of cases; and reduced sperm quality in 21% of cases.

Transurethral microwave therapy (TUMT) uses microwaves to induce necrosis (death) of prostate tissue.

The excessive heat (>60°C) generated by the transurethral probe used in TUMT can affect nerve tissue contributing to sexual function.

8.7% of patients experience impaired erectile function following TUMT, and 17.8% experience erectile dysfunction.

Open prostatectomy, reserved for patients with a large prostate volume was associated with erectile dysfunction in 89% of patients operated on.

Embolization of the prostatic artery (EAP) is an innovative minimally invasive technique for the treatment of prostatic hyperplasia without the need for surgery.

The main advantage of this technique is that it has no long-term impact on erectile or urinary function. In 32% of cases, EAP can even improve erectile function.

Decreased ejaculate was reported in 16% of patients.

A study by Hakimé and colleagues at the Centre Adénome Prostate (European Radiology: in press) on the effects of EAP, which preserves the arteries of the seminal vesicles, found a reduction in ejaculate volume in less than 3 % of cases.

Le Rezum is a technique that uses steam to reduce the size of the prostate. This technique results in a low rate of retrograde ejaculation <10 % and no erectile dysfunction. It requires a catheter for 2 to 3 days due to hematuria, and is only applicable to prostates weighing over 80g.

The urolift involves inserting a nitinol stent (small metal spring) into the urinary tract compressed by the prostate to keep it open. It does not cause retrograde ejaculation or erectile dysfunction. The stent must be changed regularly, and is not applicable to prostates weighing more than 80g.

For prostates weighing less than 80 g, prostatic artery embolization, rezum and urolift are the three techniques that do not affect sexual function. However, for prostates over 80 g, prostatic embolization is the only technique that best preserves the patient's sexual and urinary functions.

*Retrograde ejaculation: excretion of semen into the bladder instead of into the urethra.

*Anejaculation: absence of ejaculation

Reference : Wong et al, Techniques in Vascular and Interventional Radiology, 2020.

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