Background

Surgical treatments for lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) are affected by potentially bothersome side effects on sexual, and, above all, ejaculatory function. Several minimally invasive techniques have been proposed in the last years in order to overcome these consequences. Our aim is to summarize and evaluate the efficacy on LUTS relieve and the impact on sexual/ejaculatory function of Rezum, prostate artery embolization (PAE), implantation of a prostatic urethral lift (PUL) and the temporary implantable nitinol device (TIND).

Methods

A systematic review of the English-language literature was conducted using the MEDLINE, Embase, and Web of Science databases from January 2000 to October 2022, according to the PRISMA guidelines (PROSPERO ID: CRD42023466515). Randomized controlled trials (RCTs), prospective studies and non-comparative or comparative studies assessing the impact on functional and ejaculatory function after minimally invasive surgical therapies for Male LUTS were evaluated. Risk of bias assessment was performed according to the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool for comparative studies, and the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) for RCTs.

Results

Overall, 47 studies were included (n = 4 for TIND; n = 9 for Rezum; n = 13 for PUL; n = 21 for PAE). Most studies relied on prospective patient cohorts and were rated as low risk of bias. Across studies assessing the efficacy of Rezum, a significant improvement in terms of IPSS (ranging from −47% to −56%) and Qmax (ranging from +39% to +87%) was reported. On the other hand, according to IIEF-5 score, Rezum had a minimal impact on sexual function (ranging from −1% to −3%). PUL showed a positive impact on IPSS (ranging from −35% to −58.2%) and Qmax (ranging from +49.9% to +114.7%) and sexual function. Finally, PAE showed encouraging functional results with IPSS score reducing from −12.8% to 63.3% and Qmax improving from +8% to 114.9% but the available evidence regarding the potential impact of PAE on sexual outcomes were limited.

Conclusion

Rezum, PAE, PUL and TIND are safe and feasible techniques associated with a significant functional improvement. While available data suggest a minimal impact of Rezum and PUL on ejaculatory function, the evidence after PAE and TIND are still limited. Therefore, our review lays the foundation for further research aiming to identify the criteria to select best candidates for uMIST to tailor the management in light of specific patient- and disease- factors.

中文翻译：

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微创手术治疗良性前列腺增生引起的男性下尿路症状对射精功能的影响：系统评价

背景

良性前列腺梗阻 (BPO) 引起的下尿路症状 (LUTS) 的手术治疗可能会受到对性功能、尤其是射精功能的潜在副作用的影响。为了克服这些后果，近年来已经提出了几种微创技术。我们的目的是总结和评估Rezum、前列腺动脉栓塞（PAE）、前列腺尿道提升术（PUL）植入和临时植入式镍钛诺装置（TIND）对LUTS缓解的疗效以及对性/射精功能的影响。

方法

根据 PRISMA 指南（PROSPERO ID：CRD42023466515），使用 MEDLINE、Embase 和 Web of Science 数据库对 2000 年 1 月至 2022 年 10 月期间的英语文献进行了系统回顾。评估男性 LUTS 微创手术治疗后对功能和射精功能影响的随机对照试验 (RCT)、前瞻性研究和非比较或比较研究。偏倚风险评估根据用于比较研究的非随机干预研究偏倚风险 (ROBINS-I) 工具和用于随机对照试验的修订版 Cochrane 随机试验偏倚风险工具 (RoB 2) 进行。

结果

总体而言，纳入了 47 项研究（ TIND 的n = 4 项；  Rezum 的n = 9 项；PUL 的n  = 13 项； PAE 的n  = 21 项）。大多数研究依赖于前瞻性患者队列，并且被评为低偏倚风险。在评估 Rezum 功效的研究中，报告显示 IPSS（范围从 -47% 到 -56%）和 Qmax（范围从 +39% 到 +87%）显着改善。另一方面，根据 IIEF-5 评分，Rezum 对性功能的影响最小（范围从 -1% 到 -3%）。 PUL 对 IPSS（范围从 -35% 到 -58.2%）和 Qmax（范围从 +49.9% 到 +114.7%）和性功能有积极影响。最后，PAE 显示出令人鼓舞的功能结果，IPSS 评分从 -12.8% 降低至 63.3%，Qmax 从 +8% 提高至 114.9%，但有关 PAE 对性结果潜在影响的现有证据有限。

结论

Rezum、PAE、PUL 和 TIND 是安全可行的技术，可显着改善功能。虽然现有数据表明 Rezum 和 PUL 对射精功能的影响很小，但 PAE 和 TIND 后的证据仍然有限。因此，我们的审查为进一步研究奠定了基础，旨在确定选择 uMIST 最佳候选者的标准，以便根据特定的患者和疾病因素调整管理。