Background: The treatment options for male lower urinary tract symptoms (LUTS) widely range from self-monitoring to oral medications to surgical procedures. As far as concerns surgical treatment of obstructive LUTS, transurethral incision of the prostate is considered as the gold standard in patients with mild benign prostatic enlargement. Objectives: The aim of our study is to describe this novel approach to perform ejaculation sparing Holmium laser bladder neck incision (ES-HoBNI), with particular regard to its effect on ejaculation and LUTS relief. Methods: We evaluated prospective clinical data from 143 consecutive patients who underwent ES-HoBNI at our institution from January 2012 to February 2018. Procedures were performed with a continuous flow 26 Ch resectoscope and a 550 µm holmium laser end-fire fiber. The stenotic bladder neck was deeply incised at 3 and 9’o clock down to the prostatic capsule in a retrograde direction to either side in front of the veromontanum. Results: Median Qmax, postvoid residual volume, International Prostate Symptom Score, and quality of life were 9 mL/s (7.4–10.2), 130 mL (100–190), 15 (13–19), and 3 (2–4), respectively. In total, 110 (76.9) reported regular anterograde ejaculation. Median operative time was 20 min (15–26). Median catheterization time and hospital stay were 3 days (3–4) and 22 h (20–24), respectively. Moreover, we have compared the frequency of anterograde ejaculation, which slightly increases after ES-HoBNI (77 vs. 81.2%) when compared to baseline data, despite not reaching statistical significancy. Conclusions: ES-HoBNI is a safe, reproducible technique to relieve obstructive LUTS in men with small prostates while preserving ejaculation in younger and sexually active individuals.

Keywords:
Bladder neck incision, Holmium laser, Ejaculation
1.
De Ridder D, Roumeguère T, Kaufman L. Urgency and other lower urinary tract symptoms in men aged ≥ 40 years: a Belgian epidemiological survey using the ICIQ-MLUTS questionnaire.
Int J Clin Pract
. 2015 Mar; 69(3): 358–65.
2.
Kaplan SA. Use of alpha-adrenergic inhibitors in treatment of benign prostatic hyperplasia and implications on sexual function.
Urology
. 2004 Mar; 63(3): 428–34.
3.
Capogrosso P, Serino A, Ventimiglia E, Boeri L, Dehò F, Damiano R, et al. Effects of silodosin on sexual function - realistic picture from the everyday clinical practice.
Andrology
. 2015 Nov; 3(6): 1076–81.
4.
Lourenco T, Shaw M, Fraser C, MacLennan G, N’Dow J, Pickard R. The clinical effectiveness of transurethral incision of the prostate: a systematic review of randomised controlled trials.
World J Urol
. 2010 Feb; 28(1): 23–32.
5.
Bansal A, Sankhwar S, Kumar M, Jhanwar A, Purkait B, Aeron R, et al. Holmium Laser vs Monopolar Electrocautery Bladder Neck Incision for Prostates Less Than 30 Grams: A Prospective Randomized Trial.
Urology
. 2016 Jul; 93: 158–63.
6.
Elkoushy MA, Elshal AM, Elhilali MM. Holmium laser transurethral incision of the prostate: can prostate size predict the long-term outcome?
Can Urol Assoc J
. 2015 Jul-Aug; 9(7-8): 248–54.
7.
Porreca A, Noale M, Artibani W, Bassi PF, Bertoni F, Bracarda S, et al.; Pros-IT CNR study group. Disease-specific and general health-related quality of life in newly diagnosed prostate cancer patients: the Pros-IT CNR study.
Health Qual Life Outcomes
. 2018 Jun; 16(1): 122.
8.
Noale M, Maggi S, Artibani W, Bassi PF, Bertoni F, Bracarda S, et al.; Pros-IT CNR study group. Pros-IT CNR: an Italian prostate cancer monitoring project.
Aging Clin Exp Res
. 2017 Apr; 29(2): 165–72.
9.
Schiavina R, Vagnoni V, D’Agostino D, Borghesi M, Salvaggio A, Giampaoli M, et al. “In-bore” MRI-guided Prostate Biopsy Using an Endorectal Nonmagnetic Device: A Prospective Study of 70 Consecutive Patients.
Clin Genitourin Cancer
. 2017 Jun; 15(3): 417–27.
10.
Schiavina R, Borghesi M, Brunocilla E, Romagnoli D, Diazzi D, Giunchi F, et al. The biopsy Gleason score 3+4 in a single core does not necessarily reflect an unfavourable pathological disease after radical prostatectomy in comparison with biopsy Gleason score 3+3: looking for larger selection criteria for active surveillance candidates.
Prostate Cancer Prostatic Dis
. 2015 Sep; 18(3): 270–5.
11.
Yamanishi T, Kaga K, Fuse M, Shibata C, Kamai T, Uchiyama T. Six-year follow up of silodosin monotherapy for the treatment of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: what are the factors for continuation or withdrawal?
Int J Urol
. 2015 Dec; 22(12): 1143–8.
12.
Cindolo L, Pirozzi L, Sountoulides P, Fanizza C, Romero M, Castellan P, et al. Patient’s adherence on pharmacological therapy for benign prostatic hyperplasia (BPH)-associated lower urinary tract symptoms (LUTS) is different: is combination therapy better than monotherapy?
BMC Urol
. 2015 Sep; 15(1): 96.
13.
Kawabe K, Yoshida M, Homma Y; Silodosin Clinical Study Group. Silodosin, a new alpha1A-adrenoceptor-selective antagonist for treating benign prostatic hyperplasia: results of a phase III randomized, placebo-controlled, double-blind study in Japanese men.
BJU Int
. 2006 Nov; 98(5): 1019–24.
14.
Reich O, Gratzke C, Stief CG. Techniques and long-term results of surgical procedures for BPH.
Eur Urol
. 2006 Jun; 49(6): 970–8.
15.
Madersbacher S, Lackner J, Brössner C, Röhlich M, Stancik I, Willinger M, et al.; Prostate Study Group of the Austrian Society of Urology. Reoperation, myocardial infarction and mortality after transurethral and open prostatectomy: a nation-wide, long-term analysis of 23,123 cases.
Eur Urol
. 2005 Apr; 47(4): 499–504.
16.
Wasson JH, Bubolz TA, Lu-Yao GL, Walker-Corkery E, Hammond CS, Barry MJ; Patient Outcomes Research Team for Prostatic Diseases. Transurethral resection of the prostate among medicare beneficiaries: 1984 to 1997.
J Urol
. 2000 Oct; 164(4): 1212–5.
17.
D’Addessi A, Porreca A, Foschi N, Racioppi M. Thick loop prostatectomy in the endoscopic treatment of benign prostatic hyperplasia: results of a prospective randomised study.
Urol Int
. 2005; 74(2): 114–7.
18.
Madersbacher S, Marberger M. Is transurethral resection of the prostate still justified?
BJU Int
. 1999 Feb; 83(3): 227–37.
19.
Aho TF, Gilling PJ, Kennett KM, Westenberg AM, Fraundorfer MR, Frampton CM. Holmium laser bladder neck incision versus holmium enucleation of the prostate as outpatient procedures for prostates less than 40 grams: a randomized trial.
J Urol
. 2005 Jul; 174(1): 210–4.
20.
Neykov KG, Panchev P, Georgiev M. Late results after transurethral bladder neck incision.
Eur Urol
. 1998; 33(1): 73–8.
21.
Jahnson S, Dalén M, Gustavsson G, Pedersen J. Transurethral incision versus resection of the prostate for small to medium benign prostatic hyperplasia.
Br J Urol
. 1998 Feb; 81(2): 276–81.
22.
Kabalin JN, Gilling PJ, Fraundorfer MR. Application of the holmium:YAG laser for prostatectomy.
J Clin Laser Med Surg
. 1998 Feb; 16(1): 21–7.
© 2019 S. Karger AG, Basel
2019
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.