Keyword: Sexual Function
1 result found.
Perspective Article
Journal of Urology and Andrology Research, 1(1), 2026, juar004
ABSTRACT:
Primary objective: To systematically evaluate and synthesize current clinical evidence on the impact of prostatic artery embolization (PAE) on erectile and ejaculatory function in men treated for benign prostatic hyperplasia (BPH).
Secondary objectives: To summarize, where reported, changes in prostate volume, PSA, IPSS/QoL, procedure-related adverse events, and cost-effectiveness data. These are presented separately from, and do not substitute for, the primary sexual-function analysis.
Materials and methods: A systematic review was conducted in accordance with the PRISMA 2020 statement. Four databases (PubMed/MEDLINE, Embase, Cochrane CENTRAL, Scopus) were searched to June 2026. Eligible studies were RCTs and prospective cohort studies reporting IIEF-5 and/or MSHQ-EjD outcomes with a minimum 3-month follow-up. Risk of bias was assessed with RoB 2 (randomized trials), ROBINS-I (non-randomized comparative studies), and the Newcastle–Ottawa Scale (single-arm cohorts). Certainty of evidence was evaluated using the GRADE approach. The protocol was not prospectively registered in PROSPERO (acknowledged as a limitation). Given clinical and methodological heterogeneity across studies, a quantitative meta-analysis was not performed; a narrative synthesis is presented.
Results: PAE was associated with a markedly lower rate of retrograde ejaculation (0–5%) than TURP or laser enucleation (56–85%), and with a stable-to-modestly-improved IIEF-5 score (+1.5 to +2.5 points at 12 months), attributed largely to LUTS relief and discontinuation of alpha-blockers/5-ARIs rather than a direct vascular effect on erectile tissue.
Conclusion: Current evidence supports PAE as an organ-preserving option with a superior sexual-function profile relative to TURP/HoLEP for sexually active men with BPH who prioritize preservation of antegrade ejaculation, though the certainty of this evidence is limited by open-label trial designs, non-validated outcome measures in several studies, and the absence of prospective registration.
Secondary objectives: To summarize, where reported, changes in prostate volume, PSA, IPSS/QoL, procedure-related adverse events, and cost-effectiveness data. These are presented separately from, and do not substitute for, the primary sexual-function analysis.
Materials and methods: A systematic review was conducted in accordance with the PRISMA 2020 statement. Four databases (PubMed/MEDLINE, Embase, Cochrane CENTRAL, Scopus) were searched to June 2026. Eligible studies were RCTs and prospective cohort studies reporting IIEF-5 and/or MSHQ-EjD outcomes with a minimum 3-month follow-up. Risk of bias was assessed with RoB 2 (randomized trials), ROBINS-I (non-randomized comparative studies), and the Newcastle–Ottawa Scale (single-arm cohorts). Certainty of evidence was evaluated using the GRADE approach. The protocol was not prospectively registered in PROSPERO (acknowledged as a limitation). Given clinical and methodological heterogeneity across studies, a quantitative meta-analysis was not performed; a narrative synthesis is presented.
Results: PAE was associated with a markedly lower rate of retrograde ejaculation (0–5%) than TURP or laser enucleation (56–85%), and with a stable-to-modestly-improved IIEF-5 score (+1.5 to +2.5 points at 12 months), attributed largely to LUTS relief and discontinuation of alpha-blockers/5-ARIs rather than a direct vascular effect on erectile tissue.
Conclusion: Current evidence supports PAE as an organ-preserving option with a superior sexual-function profile relative to TURP/HoLEP for sexually active men with BPH who prioritize preservation of antegrade ejaculation, though the certainty of this evidence is limited by open-label trial designs, non-validated outcome measures in several studies, and the absence of prospective registration.
