(045) EVALUATING SEXUAL FUNCTION OUTCOMES IN PATIENT’S UNDERGOING TRANSURETHRAL BIPOLAR ENUCLEATION OF THE PROSTATE
Authors: Parikh N , Vasdev R , Ellythy L , Warner J 
Published: December 2024

Abstract

Introduction
Transurethral bipolar enucleation of the prostate (TUBE) is an enucleation procedure with similar functional urinary outcomes to holmium laser enucleation of the prostate (HoLEP). In comparison to the steep learning curve associated with HoLEP, TUBE appears to be more easily reproductible likely due to pre-existing familiarity with instrumentation. Despite the significant benefits associated with TUBE, retrograde ejaculation has been shown to occur in approximately 44.3% of patients.

Objective
Patient perspectives have previously emphasized the importance of preserving erectile and ejaculatory function, however the lack of subjective and objective data after TUBE makes it difficult to determine the overall impact on sexual function. We therefore sought to assess the objective and subjective sexual outcomes in men undergoing TUBE.

Methods
After IRB approval, a retrospective review of 112 patients undergoing transurethral bipolar enucleation procedures with a single surgeon at a tertiary care center was analyzed. The database included patient demographics, prostate information, preoperative uroflow medication, preoperative bladder management, intraoperative characteristics, and pre- and post-operative IIEF scores. To evaluate subjective patient responses, a 21-question survey incorporating the IIEF score and subjective questions to determine ejaculatory, orgasmic, and erectile function was disseminated.

Results
On objective analysis, smaller prostate size was significantly associated with a lower post-operative sexual satisfaction (p &lt; 0.023). Larger prostates (&gt;125 g & 75-125 g) and the absence of a median lobe were significantly and independently associated with larger changes in post-operative intercourse satisfaction scores (p &lt; 0.05). Intraoperative morcellation, medication usage, preoperative bladder management, and demographic characteristics were not associated with sexual satisfaction scores. On subjective analysis, twenty-seven percent of patients were not engaging in sexual activity post-procedurally. Of the patients that were sexually active, 24% were able to achieve an erection, 36% were almost always or always able to ejaculate, 57% continued to orgasm or climax, and 50% experienced sexual desire more than half of the time. However, 18% of men noted ejaculatory dysfunction contributed to diminished orgasmic function and sensation issues and 37% noted dissatisfaction with orgasms.

Conclusions
To our knowledge, this is the first study to analyze objective and subjective patient responses to sexual function post-TUBE surgery. On objective analysis, improvements in intercourse satisfaction following TUBE surgery were more common in patients with larger prostate sizes and presence of a median lobe. On subjective analysis, erectile satisfaction rates remained high, however patients endorsed issues with orgasm and ejaculatory function, often associated with retrograde ejaculation. This data will allow us to improve patient counseling preoperatively and potentially offer less aggressive operations in patients who prioritize sexual function.

Disclosure
No.