Sexual dysfunction in men after treatment for lower urinary tract symptoms: evidence from randomised controlled trial.
OBJECTIVE
To examine the impact on sexual function of treatments for lower urinary tract symptoms in men.


METHODS
Multicentre pragmatic randomised controlled trial of standard surgery (transurethral resection of the prostate), non-contact laser therapy, and conservative management (no active intervention).


METHODS
Three clinical centres in the United Kingdom.


METHODS
340 men aged between 48 and 90 years with lower urinary tract symptoms related to benign prostatic enlargement.


METHODS
ICSsex questionnaire items concerned with erectile stiffness, ejaculatory volume, pain or discomfort on ejaculation, whether sex life was spoilt by urinary symptoms.


RESULTS
Erectile and ejaculatory dysfunction were common (70%) and problematic at baseline and showed the expected trends with ageing. After treatment, reduced ejaculation was reported in all groups but was not significantly worse after standard surgery than after laser therapy. Erectile function was significantly improved after standard surgery; no significant difference was found between standard surgery and laser therapy (odds ratio 0.70, 95% confidence interval 0.36 to 1.38). Standard surgery was significantly better at relieving pain or discomfort on ejaculation than either conservative management (0.06, 0.007 to 0.49) or laser therapy (0.09, 0.01 to 0.73).


CONCLUSIONS
Compared with laser therapy standard surgery for lower urinary tract symptoms has a beneficial effect on aspects of sexual function-particularly in improving erectile function and reducing reported pain or discomfort on ejaculation. Older men who need treatment and want to retain or improve sexual function may thus want to consider standard surgery rather than non-contact laser therapy.
Brookes
Sara T
ST
Department of Social Medicine, University of Bristol, Canynge Hall, Bristol BS8 2PR. Sara.T.Brookes@bristol.ac.uk
Donovan
Jenny L
JL
Peters
Tim J
TJ
Abrams
Paul
P
Neal
David E
DE
D000368:Aged; D000369:Aged, 80 and over; D004542:Ejaculation; D007172:Erectile Dysfunction / Q000209:etiology / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011470:Prostatic Hyperplasia / Q000150:complications / Q000601:surgery*; D012735:Sexual Dysfunction, Physiological / Q000209:etiology*; D011795:Surveys and Questionnaires; D020728:Transurethral Resection of Prostate / Q000009:adverse effects; D014555:Urination Disorders / Q000150:complications / Q000601:surgery*