title: Effects of holmium laser enucleation of the prostate on sexual function.
abstract: OBJECTIVE
  To evaluate the effects of holmium laser enucleation of the prostate (HoLEP) on sexual function.
  
  
  METHODS
  A retrospective analysis of 202 sexually active patients who underwent HoLEP was performed. Patients were assessed at baseline and 3 and 12 months post-HoLEP. Evaluations included uroflowmetry and symptom questionnaires (five-item version of the International Index of Erectile Function [IIEF-5], ICIQ-male sexual matters associated with LUTS [ICIQ-MLUTSsex], American Urological Association symptom score [AUA-SS], and single-question quality of life [QoL] score). Nonparametric, Fisher's exact, and chi-squared tests were used to assess changes from baseline and to identify risk factors, if any, associated with deterioration of sexual function after surgery.
  
  
  RESULTS
  No significant differences were found between the preoperative and postoperative scores on the questionnaires that evaluated erection quality. However, 6.9% and 12.4% of the patients reported an increase or a reduction, respectively, of greater than five points in total IIEF-5 score. The reduction in IIEF-5 score was statistically significant only in the subgroup of patients without preoperative erectile dysfunction (ED). No preoperative characteristics and no parameters related to the surgery or postoperative outcome were significantly associated with the impairment of erection quality after surgery. In fact, neither capsular perforation nor the total laser energy used during the procedure affected erections. Loss of antegrade ejaculation was found in 70.3% of patients, while 21% reported a reduction in semen quantity. However, concern regarding ED or ejaculatory dysfunctions decreased with surgery.
  
  
  CONCLUSIONS
  Although erectile function was not altered in the vast majority of patients after HoLEP, patients without preoperative ED displayed a relatively small, but still significant, negative effect on erections. The overwhelming majority of patients suffered from retrograde ejaculation after surgery.
authors.affiliation: Department of Urology, Hospital Vall d'Hebron , Barcelona, Spain; and Universitat Autònoma de Barcelona, Barcelona, Spain .
authors.forename: José
authors.initials: J
authors.lastname: Placer
authors.forename: Carlos
authors.initials: C
authors.lastname: Salvador
authors.forename: Jacques
authors.initials: J
authors.lastname: Planas
authors.forename: Enrique
authors.initials: E
authors.lastname: Trilla
authors.forename: David
authors.initials: D
authors.lastname: Lorente
authors.forename: Ana
authors.initials: A
authors.lastname: Celma
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: López
authors.forename: Juan
authors.initials: J
authors.lastname: Morote
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004542:Ejaculation; D007172:Erectile Dysfunction / Q000453:epidemiology*; D006801:Humans; D053685:Laser Therapy; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010410:Penile Erection; D011183:Postoperative Complications / Q000453:epidemiology*; D011470:Prostatic Hyperplasia / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology; D011795:Surveys and Questionnaires; D020728:Transurethral Resection of Prostate / Q000379:methods*