(126) Comparative Study of the Effect of Holmium Laser Enucleation of the Prostate Versus Water Vapor Therapy on Sexual Function

Abstract Introduction Benign prostatic hyperplasia (BPH) surgery may affect men's sexual life, particularly erectile and ejaculatory functions. Holmium laser enucleation of the prostate (HoLEP) and water vapor thermal therapy (Rezum) are well-established surgical options, but their comparative impact on sexual and urinary outcomes remains under investigation. Objective To compare the effects of HoLEP versus Rezum on sexual function, ejaculation, and urinary parameters in men undergoing surgery for benign prostatic hyperplasia. Methods In this randomized clinical trial, 110 patients with BPH (54 HoLEP, 56 Rezum) were enrolled between April 2024 and June 2025. Baseline characteristics included age, prostate volume, PSA, BMI, diabetes, hypertension, and baseline scores of the International Index of Erectile Function (IIEF-15), Male Sexual Health Questionnaire (MSHQ), and International Prostate Symptom Score (IPSS). Perioperative and functional outcomes were assessed, including Qmax, post-void residual (PVR), operative time, hemoglobin change, catheterization time, and hospital stay. Follow-up was conducted for 12 months. Results At 12 months, no significant difference was observed in total IIEF scores (mean 50.0 vs. 54.0, p = 0.09) or erectile function domain (mean 20.0 vs. 21.0, p = 0.53). However, Rezum preserved orgasmic function better (IIEF-OF: 7.59 vs. 6.73, p = 0.002) and intercourse satisfaction (IIEF-IS: 9.37 vs. 8.25, p = 0.01). Ejaculatory function (MSHQ-EjD) was significantly better after Rezum (median 7.0 vs. 5.0, p = 0.04). HoLEP patients experienced a greater decline in MSHQ scores (−2.33 vs. −0.65, p = 0.007), consistent with higher rates of retrograde ejaculation. Regarding urinary outcomes, HoLEP showed superior improvement in IPSS (median 6.0 vs. 11.0, p < 0.001), Qmax (22.09 vs. 13.69 mL/s, p < 0.001), and PVR reduction (−117.63 vs. −95.27 mL, p = 0.033). Operative time was longer with HoLEP (117.9 vs. 19.6 minutes, p < 0.001), accompanied by greater hemoglobin decrease (2.49 vs. 0.37 g/dL, p < 0.001) and longer hospital stay (1.81 vs. 1.29 days, p < 0.001). Conversely, Rezum required longer postoperative catheterization (6.75 vs. 2.69 days, p < 0.001). Conclusions Both HoLEP and Rezum are effective for BPH management but differ in functional outcomes. Rezum better preserves orgasmic and ejaculatory function, while HoLEP provides superior urinary improvements. Erectile function was minimally affected by either technique. Surgical choice should be individualized, balancing sexual preservation against urinary symptom relief. Disclosure No