Abstract：
BACKGROUND: To report ejaculatory and urinary results in patients who underwent holmium laser enucleation of the prostate (HoLEP) with selective laser enucleation of the median lobe (MLHoLEP).
METHODS: Patients with lower urinary tract symptoms (LUTS)/benign prostatic obstruction (BPO) who underwent MLHoLEP to preserve ejaculatory function in a single center were retrospectively identified. Urinary function was assessed using International Prostate Score Symptom (IPSS), IPSS-Quality of Life index (IPSS-QoL), peak urinary flow (Qmax) and postvoid residual (PVR). Erectile function was assessed using International Index of Erectile Function (IIEF-5). In patients with preoperative antegrade ejaculation, retrograde ejaculation was routinely screened at each follow-up visit. Sexual and urinary functions at 3 and 12 months were compared with baseline values.
RESULTS: A total of 55 patients met our inclusion criteria. A significant improvement in the IPSS, IPSS-QoL, PVR and Qmax was found at 3 and 12 months, compared with baseline (all P<0.05). Eight patients (14.5%) required surgical reintervention due to persistant LUTS/BPO. No significant changes in the erectile function were found at 3 (P=0.3) and 12 months (P>0.9). In patients with preoperative antegrade ejaculation (n=32), only four cases of de novo retrograde ejaculation were recorded postoperatively.
CONCLUSIONS: MLHoLEP represents a new alternative for men with LUTS/BPO who wish to preserve their ejaculatory function. Patients should be aware that improvement in urinary function may be inferior to the traditional technique, with a higher reintervention rate due to persistent LUTS.
METHODS: Grade 4.
METHODS: Patients with lower urinary tract symptoms (LUTS)/benign prostatic obstruction (BPO) who underwent MLHoLEP to preserve ejaculatory function in a single center were retrospectively identified. Urinary function was assessed using International Prostate Score Symptom (IPSS), IPSS-Quality of Life index (IPSS-QoL), peak urinary flow (Qmax) and postvoid residual (PVR). Erectile function was assessed using International Index of Erectile Function (IIEF-5). In patients with preoperative antegrade ejaculation, retrograde ejaculation was routinely screened at each follow-up visit. Sexual and urinary functions at 3 and 12 months were compared with baseline values.
RESULTS: A total of 55 patients met our inclusion criteria. A significant improvement in the IPSS, IPSS-QoL, PVR and Qmax was found at 3 and 12 months, compared with baseline (all P<0.05). Eight patients (14.5%) required surgical reintervention due to persistant LUTS/BPO. No significant changes in the erectile function were found at 3 (P=0.3) and 12 months (P>0.9). In patients with preoperative antegrade ejaculation (n=32), only four cases of de novo retrograde ejaculation were recorded postoperatively.
CONCLUSIONS: MLHoLEP represents a new alternative for men with LUTS/BPO who wish to preserve their ejaculatory function. Patients should be aware that improvement in urinary function may be inferior to the traditional technique, with a higher reintervention rate due to persistent LUTS.
METHODS: Grade 4.
摘要：
背景：报告前列腺钬激光剥除术（HoLEP）和正中叶选择性激光剥除术（MLHoLEP）患者的射精和排尿结果。
方法：对在单中心接受MLHoLEP以保持射精功能的下尿路症状（LUTS）/良性前列腺梗阻（BPO）患者进行回顾性分析。使用国际前列腺评分症状（IPSS）评估泌尿功能，IPSS-生活质量指数(IPSS-QoL)尿流峰值（Qmax）和排尿后残留（PVR）。使用国际勃起功能指数（IIEF-5）评估勃起功能。在术前顺行射精的患者中，每次随访时常规筛查逆行射精.将3个月和12个月时的性功能和泌尿功能与基线值进行比较。
结果：共有55例患者符合我们的纳入标准。IPSS的重大改进，IPSS-QoL,在3个月和12个月时发现PVR和Qmax，与基线相比(均P<0.05)。八名患者（14.5％）由于持续的LUTS/BPO而需要手术再干预。在3个月（P=0.3）和12个月（P>0.9）时，勃起功能无明显变化。在术前顺行射精的患者中（n=32），术后仅记录了4例从头逆行射精。
结论：MLHoLEP代表了希望保留射精功能的LUTS/BPO男性的新选择。患者应该意识到，泌尿功能的改善可能不如传统技术，由于持续性LUTS，再干预率较高。
方法：4级。
方法：对在单中心接受MLHoLEP以保持射精功能的下尿路症状（LUTS）/良性前列腺梗阻（BPO）患者进行回顾性分析。使用国际前列腺评分症状（IPSS）评估泌尿功能，IPSS-生活质量指数(IPSS-QoL)尿流峰值（Qmax）和排尿后残留（PVR）。使用国际勃起功能指数（IIEF-5）评估勃起功能。在术前顺行射精的患者中，每次随访时常规筛查逆行射精.将3个月和12个月时的性功能和泌尿功能与基线值进行比较。
结果：共有55例患者符合我们的纳入标准。IPSS的重大改进，IPSS-QoL,在3个月和12个月时发现PVR和Qmax，与基线相比(均P<0.05)。八名患者（14.5％）由于持续的LUTS/BPO而需要手术再干预。在3个月（P=0.3）和12个月（P>0.9）时，勃起功能无明显变化。在术前顺行射精的患者中（n=32），术后仅记录了4例从头逆行射精。
结论：MLHoLEP代表了希望保留射精功能的LUTS/BPO男性的新选择。患者应该意识到，泌尿功能的改善可能不如传统技术，由于持续性LUTS，再干预率较高。
方法：4级。
