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

World J Urol. 2020 Oct;38(10):2595-2599. doi: 10.1007/s00345-019-03036-7. Epub 2019 Dec 7.

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.

Keywords: Anejaculation; Benign prostatic hyperplasia; Diminished ejaculation; Ejaculatory disorders; Prostatic artery embolization; Retrograde ejaculation.

MeSH terms

  • Aged
  • Arteries
  • Ejaculation*
  • Embolization, Therapeutic / adverse effects*
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Prostate / blood supply*
  • Prostatic Hyperplasia / therapy*
  • Randomized Controlled Trials as Topic
  • Sexual Dysfunction, Physiological / etiology*