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LBA-07 EJACULATORY HOOD SPARING VS. STANDARD GREENLIGHTTM LASER PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE: SEXUAL AND URODYNAMIC ASSESSMENT THROUGH RANDOMIZED CONTROLLED TRIAL (RCT)

INTRODUCTION AND OBJECTIVES: Ejaculatory dysfunction has been reported as a price for successful relief of benign prostatic obstruction. Attempts to preserve ejaculation have been described however; concerns about potential re-obstruction are never solved. In this trial, we assessed the efficacy of EH-sparing Greenlight Laser photoselective vaporization of the prostate (GL.PVP) in preserving antegrade ejaculation and urodynamic relief of obstruction in comparison to standard GL.PVP. METHODS: Between November 2015 and September 2017, 46 out of 50 sexually active BPH patients were randomized for the study. Standard GL.PVP was performed as classically described with TURP like cavity as end point of vaporization. EH-sparing GL.PVP was performed with preservation of the paracollicular and supracollicular tissue present proximal to verumontanum. Patients were assessed at baseline and postoperatively at 1, 6 and 12 months using Ej-MSHQ and IIEF-15. Urinary symptoms were assessed using IPSS-QoL, uroflow and PVR at baseline and different follow up points. Standard urodynamic study (UDS) was performed at 6 months. RESULTS: At time of analysis, 24 EH-sparing GL.PVP and 22 standard GL.PVP procedures were evaluable. Antegrade ejaculation was reported in 85% after EH-sparing GL.PVP and in 31.6% after standard GL.PVP (P=0.001). Significant reduction in EJ-MSHQ score was reported after standard GL.PVP at 6 and 12 months (P<0.001, <0.001) with no significant difference after EH-sparing GL.PVP, (P=0.18, P=0.078) respectively. The median EJ-MSHQ score was 28.5 (1-33), 27 (1-33) in EH-sparing GL.PVP and 9.5 (1-35), 9 (0-33) in standard GL.PVP group at 6 (P=0.005) and 12 months (p<0.001) respectively. Both groups showed declined in mean total IIEF-15 score at 1 year however, this decline was statistically significant only after standard GL.PVP (p=0.001). All urinary outcome measures showed comparable significant improvement at all follow up points. Postoperative urodynamic assessment showed significant comparable (P=0.97) decline in bladder outlet obstruction index from median 64 (21-207) to 23.5 (10-53) (P=0.005) following EH-sparing GL.PVP and from 87 (38:186) to 19.5 (7-51) (P=0.001) in the standard GL.PVP. Postoperative PSA reduction was significantly more after standard GL.PVP 69.23% (27.3:82.5) compared to 37.5% (-15.4:81.2) after EH-sparing group, (p=0.046). At one year, overall retreatment rate was comparable between the two groups (p=0.26). CONCLUSIONS: In well-informed sexually interested patients, EH-sparing GL.PVP procedure is feasible and effective for treatment of small to moderate sized BPH with superior sexual function related outcome. Short-term relief of obstruction is objectively comparable to standard GL.PVP. Source of Funding: None