Ejaculatory Hood Sparing vs. Standard GreenLightTM Laser Photoselective Vaporization of the Prostate: Sexual and Urodynamic Assessment Through Double Blinded Randomized Trial.
To assess 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 through preliminary clinical trial.Standard GL.PVP was classically performed in 24 patients. EH-sparing GL.PVP was performed with preservation of the paracollicular and supracollicular tissue present proximal to verumontanum in 25 patients. Patients were assessed at baseline and at 1, 3, 6 and 12 months postoperatively using Ej-MSHQ and IIEF-15. IPSS, uroflow and PVR were reported at each follow-up visit. Standard urodynamic study (UDS) was performed at 6 months.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 decline 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. At one year, overall retreatment rate was comparable between the two groups (p=0.26).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.