Does Greenlight HPSTM Laser Photoselective Vaporization Prostatectomy Affect Sexual Function?

Purpose: We evaluate the impact of Green Light High-Performance System (HPSTM) laser photoselective vaporization prostatectomy (PVP) on sexual function after treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Patients and Methods: We prospectively evaluated our initial single surgeon experience with Green Light HPSTM laser PVP. All patients had American Urological Association Symptom Score (AUASS), Sexual Health Inventory for Men (SHIM), maximum flow rate (Qmax), and postvoid residual (PVR) determinations. Transurethral PVP was performed using a 120W Green Light HPSTM side-firing laser system. AUASS, SHIM, Qmax, and PVR were evaluated 1, 4, 12, 24, and 52 weeks postsurgery. Wilcoxon signed rank test and the Student t-test were used to assess the changes from baseline. Results: Seventy-two patients completed 52 weeks of follow-up, having a median age of 69 (45-89) years. The median prostate volume was 62 (21-263) mL. Median AUASS improved significantly from 23 to 8, 6, 5, 5, and 4 (P < 0.05) at 1, 4, 12, 24, and 52 weeks, respectively. Median SHIM changed from 15 to 12, 16, 19, 16, and 17 during the follow-up period (P=0.032, 0.427, 0.074, 0.081, and 0.259). Minimum change (0 +/- 5) in SHIM occurred in 85.5%, 90.5%, 78.8%, 77.5%, and 73.7% of patients; 11.3%, 6.3%, 6.0%, 4.8%, and 7.0% of patients had deterioration of erectile function (SHIM reduction >5); and 3.2%, 3.2%, 15.2%, 17.7%, and 19.3% of patients had improvement of erectile function (SHIM increase >5). Incidence of new-onset retrograde ejaculation was 30%. Conclusion: GreenLight HPSTM laser PVP appears to not have a detrimental effect on erectile function.