Abstract / Summary
Abstract Background Enucleation of the prostate is effective for large glands, but the effect of the energy source on sexual function is uncertain. We compared bipolar enucleation (BipoLEP) and holmium laser enucleation (HoLEP) on erectile and ejaculatory function. Methods In a prospective, two-center randomized trial, 80 men with a prostate larger than 60 g were allocated to BipoLEP (n = 40) or HoLEP (n = 40). The primary outcome was the IIEF erectile-function domain at 6 months; secondary outcomes were the other IIEF domains, the IIEF-15 total, and the MSHQ-EjD ejaculatory domains, assessed before surgery and at 3 and 6 months. Between- and within-group comparisons were supported by a two-way mixed ANOVA and by analysis of covariance adjusting for baseline imbalances. Results The arms were comparable at baseline apart from serum prolactin and educational level. No IIEF erectile-domain score differed between techniques at any time point, including three months. Both arms improved from baseline to six months, with a significant effect of time and no time-by-technique interaction; the equivalence held after adjustment. Bipolar enucleation was associated with higher MSHQ-EjD ejaculatory frequency, strength, and total score and less bother at six months. Responder rates and de novo erectile dysfunction were similar. Conclusions Bipolar and holmium laser enucleation gave comparable erectile recovery over six months, with no short-term advantage for either technique. Bipolar enucleation was associated with somewhat better ejaculatory outcomes. Both procedures are effective options for men with large prostates, and ejaculatory function may be the more useful factor when choosing between them.