Abstract
In the article by Contreras et al., 1 the authors describe a novel approach for preservation of ejaculatory function during prostate vaporization with the XPS 180-W device. Using a technique that relies on anatomic vapo-dissection, the authors were able to demonstrate that 88% of their patients were actually able to preserve antegrade ejaculation. These results are certainly in stark contrast to the majority of the surgical lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) literature that reports loss of antegrade ejaculation in 65% to 80% of patients. Among the limitations of this article is the fact that the authors did not look at International Index of Erectile Function/Sexual Health Inventory for Men (IIEF/SHIM) scores to better understand overall postoperative sexual function. Furthermore, they used a Spanish translated nonvalidated version of the Male Sexual Health Questionnaire - Ejaculatory Dysfunction (MSHQ-EjD) Short Form questionnaire and did so retrospectively after surgery, which may have introduced bias. It is also worth noting that the median prostate size in this cohort was only 57.2 g, which would make most of the included patients eligible for lesser invasive options such as Rezum and UroLift, with significantly lower sexual, and particularly ejaculatory, side effects. Nevertheless, this is an interesting technique with good preservation of ejaculatory function. Further validation from other centers is necessary to confirm these results.