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Keywords:

  • benign prostatic enlargement;
  • benign prostatic hyperplasia;
  • erectile dysfunction;
  • lower urinary tract symptoms;
  • sex;
  • transurethral resection of the prostate

Study Type – Symptom prevalence (prospective cohort)

Level of Evidence 1b

What's known on the subject? and What does the study add?

Evidence that transurethral resection of the prostate (TURP) leads to erectile dysfunction (ED) is conflicting. Several studies claimed significant risk of ED after TURP for benign prostatic hyperplasia with some reporting complete loss of erection. Several studies have been retrospective or have not considered levels of pre-operative ED.

ED associated with lower urinary tract symptoms frequently precedes TURP. TURP did not adversely affect erectile function. Pre-operative ED can be improved by TURP and long-term erectile function is maintained following TURP. The improvement was corroborated by the partners in the short, medium and long-term and was statistically significant.

OBJECTIVE

  • • 
    To evaluate the effect of transurethral resection of the prostate (TURP) on sexual function in the short (6 months), medium (6 years) and long (12 years) term and assess the conformity between patient and partner regarding sexual function.

PATIENTS AND METHODS

  • • 
    A prospective cohort study set at the Aberdeen Royal Infirmary University Hospital.
  • • 
    A total of 280 men referred with lower urinary tract symptoms (LUTS) to a university hospital underwent TURP between January 1993 and September 1994; 145 of their partners (partner or spouse) participated.
  • • 
    Assessment included American Urological Association symptom score, flow rates and validated self-reported sexual questionnaires (SQ).
  • • 
    Data were collected at baseline, 3 months, 6 months, 6 years and 12 years of follow-up.

RESULTS

  • • 
    In all, 120 (43%) men were sexually active preoperatively. At 6 months, 73 (61%) of these 120 men completed the SQ and all were sexually active.
  • • 
    No sexually active patient became impotent after the procedure. Moreover, 27 (15%) with pre-existing erectile dysfunction reported improved sexual activity and erection quality.
  • • 
    At 6 years 101 men completed the SQ and 31 (30.7%) were sexually active. At 12 years, 36 (31.9%) of 113 who completed the SQ were sexually active.
  • • 
    Partners agreed with the men's self assessment at all visits.
  • • 
    Limitations include possible attrition bias and lack of information from non-responders.

CONCLUSIONS

  • • 
    Erectile dysfunction associated with LUTS frequently precedes TURP.
  • • 
    The TURP did not adversely affect sexual function.
  • • 
    Pre-operative erectile dysfunction can be improved by TURP and long-term sexual function is maintained after TURP. These findings, corroborated by the partners, were statistically significant.