title: Male sexual function outcome after three laser prostate surgical techniques: a single center perspective.
abstract: OBJECTIVE
  To assess the change and predictors of sexual-related outcomes after laser prostate surgery.
  
  
  METHODS
  This is a longitudinal study of 216 sexually active men who underwent laser prostatectomy between 2005 and 2010. The International Index of Erectile Function-15 questionnaire was used both preoperatively and during the first year of follow-up. Cases with unreliable answers or patients without interested partners were excluded. All relevant data of both groups were depicted and statistically analyzed.
  
  
  RESULTS
  We identified 191 patients that met the inclusion criteria, 99 holmium laser enucleation of the prostate, 34 holmium laser ablation, and 58 photoselective vaporization of the prostate (GreenLight-532-mm laser photoselective vaporization of the prostate). There were significant differences among the 3 groups regarding the International Index of Erectile Function-15 direction of change at 1 year, being unchanged in (22.2%, 24.4%, and 29.3%), improved in (60.6%, 29.4%, and 41.4), and declined in (17.2%, 41.2%, and 29.3%) in the 3 groups, respectively (P < .05). After adjusting for clinical and perioperative variables, the independent risk factors for decline in the International Index of Erectile Function score were basal International Index of Erectile Function ≥ 55 and energy to prostate ratio. In holmium laser enucleation of the prostate group, there was significant improvement of the mean overall score, erectile function, desire, and intercourse satisfaction domains (P < .05). In holmium laser ablation and photoselective vaporization of the prostate groups, there were no significant changes between mean preopeative and postoperative scores (P > .05). The incidence of new onset retrograde ejaculation in the holmium laser enucleation of the prostate group was (77.3%) significantly different compared to (31.1%) in the holmium laser ablation group and (33.2%) in photoselective vaporization of the prostate group (P < .05).
  
  
  CONCLUSIONS
  Laser prostate surgery using more size-related laser energy might have possible negative influence on sexual function. Patients with normal preoperative sexuality are more at risk.
authors.affiliation: McGill Prostate Center, McGill University, Montreal, Quebec, Canada.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Elshal
authors.forename: Hazem M
authors.initials: HM
authors.lastname: Elmansy
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Elkoushy
authors.forename: Mostafa M
authors.initials: MM
authors.lastname: Elhilali
mesh_terms: D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000295:instrumentation*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D010410:Penile Erection / Q000502:physiology*; D011470:Prostatic Hyperplasia / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D019529:Sexuality / Q000502:physiology*; D011795:Surveys and Questionnaires; D013997:Time Factors; D020728:Transurethral Resection of Prostate / Q000379:methods*; D016896:Treatment Outcome; D014835:Volatilization