Evaluation of lower urinary tract symptoms and sexual functions after holmium laser prostate enucleation.

Background: Studies evaluating lower urinary tract symptoms (LUTS) and sexual functions after holmium laser enucleation of prostate (HoLEP) are very limited.

Aims: To evaluate both the LUTS voiding and storage functions of patients after HoLEP operation and to examine its effect on postoperative sexual functions.

Methods: The data of male patients who underwent HoLEP for benign prostatic hyperplasia (BPH) between May 2019 and February 2022 were evaluated. The International Prostate Symptom Index (IPSS) was used for questioning LUTS. The International Erectile Function Index-Erectile Function (IIEF-EF) section was completed to evaluate erectile functions and Male Sexual Health Questionnaire-Ejaculation function (MSHQ-EjD) was completed to evaluate ejaculation functions.

Results: A total of 427 patients were included in the study. A significant improvement was found in IPSS total, storage, and voiding scores at the 3rd month follow-ups of the patients after HoLEP. While improvement was detected in the erectile functions of the patients (p < 0.001), a significant decrease was found in MSHQ-EjD scores (15.97 ± 2.26 vs. 11.02 ± 3.69; p = 0.002). More than 50% reduction in IPSS scores was found in 85.48% (365/427) of the patients. It was determined that the patients who did not benefit from the treatment had higher preoperative IPSS-storage symptoms (p = 0.001), lower IIEF-EF scores (p < 0.001), and higher PVRs (p = 0.001).

Conclusions: HoLEP is an effective method that can be used safely and effectively in the treatment of LUTS due to BPH. While both storage and voiding functions of the patients improve, there is no worsening in erectile functions, but deterioration in ejaculation functions can be observed.