It has been demonstrated that sexual activity was common in the majority of men over 50 years old and was an important component of overall quality of life (QoL). Ejaculatory dysfunction (EjD) is the most common side effect of surgical treatment of benign prostatic obstruction (BPO). It has been considered for decades to be an inevitable consequence of restoring micturition comfort. EjD can have a substantial deleterious effect on the QoL of men with previously maintained regular sexual activity, inducing decreased orgasmic intensity and increased levels of anxiety and depression. A better understanding of the physiology of ejaculation has enabled the emergence of modified surgical techniques that aim to preserve antegrade ejaculation. Our hypothesis is that conservation of ejaculation can be achieved by modified surgical procedures without compromising functional outcomes.
Man over 40 years old
Indication of surgical management for BPH
Prostate volume ≥30 cc and ≤150 cc as evaluated by ultrasonography ( or an MRI if available)
IPSS score ≥12
Unwillingness to accept the treatment
No pre-operative ejaculation or sexuality
Neurological pathology responsible for micturition disorders
History of prostatic surgery
Parallel
Partial surgery preserving the prostatic apex
Procedure/SurgeryPartial Endoscopic resection of prostate to conserve apex
Conventional endoscopic prostatic surgery
Procedure/SurgeryEndoscopic resection of prostate.
Evaluation of IPSS (International Prostatic Symptom Score) score at 6 months
the mean IPSS score measured at 6 months, to compare the efficacy of partial endoscopic resection versus complete endoscopic resection in improvement of lower urinary tract symptoms related to BPH. IPSS scores are categorised as 'asymptomatic' (0 points), 'mildly symptomatic' (1-7 points), 'moderately symptomatic' (8-19 points), and 'severely symptomatic' (20-35 points).
Evaluation of ejaculation and global sexual life
MSHQ ejd= Male Sexual Health Questionnaire for Ejaculatory Dysfonction Scale score : \[1-20\] : a higher score mean that the subject have a ejaculatory dysfunction and sexual troubles
Evaluation of lower urinary tract symptoms
Urinary Symptom Profile (USP) : * 1a+1b+1C \[0-9\]. A higher score mean that the subject have urinary leakage * 2+3+4+4bis+5+6+7 \[0-21\]. A higher score mean that the subject have voiding urgency * 8+9+10 \[0-9\]. A higher score mean that the subject have voiding problem
Evaluation of complication rates
Complications based on Clavien Dindo classification
Evaluation of ejaculation and global sexual life
IIEF-15 (including orgasmic function: questions 9 and 10), auto-questionnaire (superiority test)
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