Ch. Lang, R. Eichel, R. Gib, Y. Al Bulushi, Sch. Alloussi
Urological Department, Städtisches Klinikum Neunkirchen, Germany
Potent men with desire for preserved ejaculation are frightened about surgical therapy in case of bladder outlet obstruction. Up to know in case of transurethral resection they have to take in mind the lost of ejaculation, depending on the resection technique. Clinical, physiological and anatomical findings have resulted in challenging the current theory about ejaculation mechanism.
Due to the revalued and innovative aspects a new technique, so called ejaculation preserving transurethral resection and Laservaporesection of the prostate (epTURP + epLaVaRP), could be established.
Material and methods
Since 2001 in 87 patients, aged 27 to 78 years, an ejaculation preserving technique of TURP is performed in form of a prospective evaluation with 5 year follow up control and since 2008 an epLaservaporesection in 28 patients aged 25 to 72 years. The outcome is examined by uroflow, residual volume, International Prostate Symptom Score (IPSS) and Live Quality Index (LQI). The post operative ejaculate is inspected in the first preliminary 50 patients by seminal fluid analysis and later on the ejaculation processes is controlled by questionnaire IIEF 5+.
In 78 of 87 (90%) patients treated by epTURP and 23 of 28 (82%) by epLaVaRP the orthogradic ejaculation could be preserved. In seminal fluid analysis a reduction of volume of 30% was shown. Micturition symptoms present a substantial improvement by decrease of IPSS about 18,5 (12,1 epLaVaRP) post operative and 19 in the long term follow up and LQI decreased by 2.9 (2,3 epLaVaRP excluding OAB patients) confirmed in the long term follow up. The functional voiding pattern like uroflow increase by 14ml/s (17,8ml/s epLaVaRP) and residual volume is reduced by 59ml in average.
- Ejaculation preserving treatment of the prostate by endoscopic monopolar and laservaporesection is possible.
- The presented techniques are suitable for ejaculation preservation.
- The functional outcome is excellent and could be confirmed in long term follow up for epTURP.
- The internal bladder neck is irrelevant for orthogradic ejaculation.
- The old concept of ejaculation physiology should be reviewed.
- No postop incontinence could be observed.