Background

The surgical landscape for Lower Urinary Tract Symptoms (LUTS) and Benign Prostatic Hyperplasia (BPH) has evolved with the introduction of Minimally Invasive Surgical Therapies (MISTs), recognizing the impact of sexual function on patients’ well-being, and prioritizing ejaculation-sparing approaches.

Methods

This systematic review explored ejaculation sparing after classic endoscopic procedures and MISTs (iTind, Rezūm, Urolift, Aquablation, and TPLA) and a literature search yielded 41 studies.

Results

While all procedures demonstrated efficacy in improving LUTS/BPH symptoms (IPSS, QoL, Qmax), a subset of studies evaluated ejaculatory function. Positive outcomes were noted, challenging the historical association of BPH surgeries with ejaculatory dysfunction. Variations in study design, patient cohorts, and limited long-term data present challenges. Notably, the lack of baseline specificity, use of alpha-blockers, and non-specific sexual function assessments underscore potential biases.

Conclusions

Despite limitations, the review tentatively concluded that MISTs, including iTind, Rezūm, Urolift, Aquablation, and TPLA, appear comparable in sparing ejaculation. Long-term studies are essential to validate sustainability, and comparative research should assess trade-offs between MISTs and traditional surgeries. Incorporating patient-reported outcomes and quality of life assessments will enhance future investigations, refining MISTs as standard therapeutic options for LUTS/BPH.

中文翻译：

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LUTS/BPH 的经典和微创手术治疗的保留射精

背景

随着微创手术疗法 (MIST) 的引入，人们认识到性功能对患者健康的影响，并优先考虑保留射精，下尿路症状 (LUTS) 和良性前列腺增生 (BPH) 的手术格局不断发展接近。

方法

这篇系统综述探讨了经典内窥镜手术和 MIST（iTind、Rezūm、Urolift、Aquablation 和 TPLA）后保留射精的情况，文献检索产生了 41 项研究。

结果

虽然所有手术都显示出改善 LUTS/BPH 症状（IPSS、QoL、Qmax）的功效，但仍有一部分研究评估了射精功能。人们注意到了积极的结果，挑战了 BPH 手术与射精功能障碍的历史联系。研究设计、患者队列的变化和有限的长期数据带来了挑战。值得注意的是，缺乏基线特异性、α-受体阻滞剂的使用以及非特异性性功能评估强调了潜在的偏差。

结论

尽管存在局限性，该综述初步得出结论认为，MIST（包括 iTind、Rezūm、Urolift、Aquablation 和 TPLA）在不射精方面似乎具有可比性。长期研究对于验证可持续性至关重要，比较研究应评估 MIST 和传统手术之间的权衡。结合患者报告的结果和生活质量评估将加强未来的研究，将 MIST 完善为 LUTS/BPH 的标准治疗选择。