Introduction: Holmium laser enucleation of the prostate (HoLEP) is recommended for prostate glands of all sizes and is becoming a popular alternative to the transurethral resection of the prostate (TURP). Side effects of the procedure include stress incontinence, irritative lower urinary tract symptoms, and sexual function, most commonly retrograde ejaculation. We sought to evaluate perioperative outcomes related to sexual function and urinary function in patients who underwent selective laser enucleation of the prostate.
Methods: We conducted a retrospective review of the first 300 cases of HoLEP was performed from April 2019 – August 2021. Thirty-two patients within our cohort underwent selective enucleation of the median lobe of the prostate. Criteria for choosing to treat patients with selective enucleation were intravesical-prostatic protrusion or high bladder neck without obstructing lateral lobes. Patients were asked to comment on whether they had retrograde ejaculation during their follow up appointment. Urinary function was assessed using the American Urological Association Symptom Score (AUA-SS) and subjective evaluation of urinary incontinence.
Results: Mean age of our cohort was 65.9 years of age. Average peri-operative AUA-SS scores significantly improved (21.7 vs 6.8, p < 0.001). Average peri-operative quality of life scores significantly improved (4.1 vs 1.4, p < 0.001). Average peri-operative post void residual volumes were significantly improved (228.8 cc vs 45.7 cc, p = 0.001). No patients reported stress urinary incontinence. Of the 32 patients who underwent selective enucleation of the median lobe, 26 were sexually active. Of those men, 22 reported normal ejaculation, 2 men had retrograde ejaculation that was unchanged from pre-op. Data was missing for 2 men.
Conclusions: In our case series of selective laser enucleation of the median lobe, urinary function significantly improved in short term follow-up with preservation of ejaculation in approximately 90% of men. A larger series is necessary with a longer follow up period to further investigate the durability of these findings. Further investigation is needed to define objective criteria to identify ideal candidates for selective median lobe enucleation.