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Ejaculatory disorders after prostatic artery embolization: a reassessment of two prospective clinical trials

Gautier Muellhaupt, Lukas Hechelhammer, Pierre-André Diener, Daniel Stephan Engeler, Sabine Güsewell, Hans-Peter Schmid, Livio Mordasini & Dominik Abt

abstract

PURPOSE
This study aims to specify and explain the previous findings of unexpectedly high rates of ejaculatory disorders, i.e. 56%, found after prostatic artery embolization (PAE) in a randomized controlled trial comparing safety and efficacy of PAE and transurethral resection of the prostate (TURP).

PATIENTS AND METHODS
Case report forms of the randomized controlled trial were analyzed to specify the grade of postoperative ejaculatory dysfunction 3 months postoperatively. In addition, study participants with assessable ejaculation were asked to complete the four-item Male Sexual Health Questionnaire-Ejaculation Dysfunction Short Form (MSHQ-EjD) referring to their ejaculatory function at present, as well as before treatment and 3 months after. Potential explanations for ejaculatory disorders after PAE were derived from histological examination of five radical prostatectomy specimens of patients that underwent PAE 6 weeks before radical prostatectomy within a proof-of-concept trial at the study site, St. Gallen Cantonal Hospital. An experienced uropathologist systematically examined the whole-gland embedded tissue with focus on structures that are involved into ejaculation.

RESULTS
While patients after TURP predominantly suffered from anejaculation (52%), diminished ejaculation was found more often after PAE (40%). Significantly higher MSHQ-EjD scores were found 3 months after PAE and at a median follow-up of 31 months. Histological examination showed marked changes of structures involved into ejaculation (e.g., prostatic glands, seminal vesicles, ejaculatory ducts) after PAE.

CONCLUSION
Although anejaculation occurs less frequently after PAE (16%) compared to TURP (52%), patients have to be informed about the relevant risk of ejaculatory disorders, especially diminished ejaculation.
   
citation Muellhaupt G, Hechelhammer L, Diener P A, Engeler D S, Güsewell S, Schmid H P, Mordasini L, Abt D. Ejaculatory disorders after prostatic artery embolization: a reassessment of two prospective clinical trials. World J Urol 2019;.
   
type journal paper/review (English)
date of publishing 07-12-2019
journal title World J Urol
ISSN electronic 1433-8726
PubMed 31813028
DOI 10.1007/s00345-019-03036-7