Sexual dysfunction in men after treatment for lower urinary tract symptoms: evidence from randomised controlled trial

Abstract

Objective: To examine the impact on sexual function of treatments for lower urinary tract symptoms in men.

Design: Multicentre pragmatic randomised controlled trial of standard surgery (transurethral resection of the prostate), non-contact laser therapy, and conservative management (no active intervention).

Setting: Three clinical centres in the United Kingdom.

Participants: 340 men aged between 48 and 90 years with lower urinary tract symptoms related to benign prostatic enlargement.

Main outcome measures: ICSsex questionnaire items concerned with erectile stiffness, ejaculatory volume, pain or discomfort on ejaculation, whether sex life was spoilt by urinary symptoms.

Results: Erectile and ejaculatory dysfunction were common (70%) and problematic at baseline and showed the expected trends with ageing. After treatment, reduced ejaculation was reported in all groups but was not significantly worse after standard surgery than after laser therapy. Erectile function was significantly improved after standard surgery; no significant difference was found between standard surgery and laser therapy (odds ratio 0.70, 95% confidence interval 0.36 to 1.38). Standard surgery was significantly better at relieving pain or discomfort on ejaculation than either conservative management (0.06, 0.007 to 0.49) or laser therapy (0.09, 0.01 to 0.73).

Conclusions: Compared with laser therapy standard surgery for lower urinary tract symptoms has a beneficial effect on aspects of sexual function-particularly in improving erectile function and reducing reported pain or discomfort on ejaculation. Older men who need treatment and want to retain or improve sexual function may thus want to consider standard surgery rather than non-contact laser therapy.

Figure 1

ICSsex questions

Figure 2

Profile of randomised trial of standard surgery, non-contact laser therapy, and conservative management

Figure 3

Change in percentage (95% confidence intervals) of men who responded to item at baseline and follow up with normal function after treatment (positive change indicates an improvement). Confidence intervals, provided for descriptive purposes only and based on exact methods with data dichotomised within each group, do not yield identical findings to either Wilcoxon P values quoted in text or primary (between group) comparisons from proportional odds models that use ordinal response data