Objectives

1. Challenge in endoscopic prostate surgery – preservation of ejaculation in TUR- and Laser Vaporesection of Prostate Objectives Potent men with desire for preserved ejaculation are frightened about surgical therapy in case of bladder outlet obstruction. Up to now in case of transurethral resection they have to take in mind the lost of ejaculation, depending on the resection technique. Clinical, physiological and anatomical findings have resulted in challenging the current theory about ejaculation mechanism. Due to the revalued and innovative aspects a new technique, so called ejaculation preserving transurethral resection and Laser Vaporesection of the prostate (epTURP + epLaVaRP), could be established and is illustrated in this video poster. Ch. Lang*, R. Eichel*, R. Gib*, A. Al Kaabneh**, S. H. Alloussi***, Sch. Alloussi* *Department of Urology, Städtisches Klinikum Neunkirchen, Germany **King Hussein Medical City, Prince Hussein Urology Center, Amman, Jordan ***Urological University Hospital Tübingen, Germany Methods Since 2001 in 87 patients, aged 27 to 78 years, an ejaculation preserving technique of TURP is performed in form of a prospective evaluation with 5 year follow up control and since 2008 an epLaserVaRP in 28 patients aged 25 to 72 years. The outcome is examined by uroflow, residual volume, International Prostate Symptom Score (IPSS) and Live Quality Index (LQI). The post operative ejaculate is inspected in the first preliminary 50 patients by seminal fluid analysis and later on the ejaculation processes is controlled by questionnaire IIEF 5+. Selection of findings challenging the theory about ejaculation mechanisme Video 3: study of preservation area: respect of 1cm around colliculus seminalis and avoidance digging a paracollicular ditch Video 4: Demonstration of ejaculation preserving TUR Prostate (epTURP) Video 5: Demonstration of ejaculation preserving Laser Vaporesection of Prostate (epLaVaRP) by RevoLix 2 micron Thullium: YAG - Laser Results Graphic 1: Micturition symptoms and Uroflow for epTURP 1. Seminal fluid analysis: 30% reduction of volume 2. Micturition symptoms and uroflow see Graphic 1 + 2 Graphic 2: Micturition symptoms and Uroflow for epLaVaRP • 78of 87 (90%) preserved orthogradic ejaculation in epTURP • 23 of 28 (82%) preserved orthogradic ejaculation in epLaVaRP Video 1: TRUS during ejaculation: direct emission of sperm in distal urethra Video 2: Ejaculation preserving transprostatic radical cystectomy New concept about ejaculation mechanism Conclusions • Ejaculation preserving treatment of the prostate by endoscopic monopolar and Laser Vaporesection is possible. • The presented techniques are suitable for ejaculation preservation. • The functional outcome is excellent and could be confirmed in long term follow up for epTURP. • The internal bladder neck is irrelevant for orthogradic ejaculation. • The old concept of ejaculation physiology should be reviewed. • No postoperative incontinence could be observed Video 6: Based on histological and anatomical findings of Dorschner 2001 an intact collicular unit is responsible for antegrade ejaculation Picture 1: Video UD in patient with lost of ejaculation after rRPLA intact internal bladder neck Picture 2: Video UD in patient with preserved ejaculation and still opened internal bladder neck