Effect of Monopolar Versus Bipolar Transurethral Resection of The Prostate on Erectile Function: A Randomized Controlled Trial with Phosphodiesterase-5 Inhibitors Users Subgroup Analysis.

Purpose: Men with lower urinary tract symptoms (LUTS) from benign prostatic hyperplasia (BPH) often experience erectile dysfunction (ED). While transurethral resection of the prostate (TURP) can improve ED, new-onset ED remains a concern. This study compares monopolar (M-TURP) and bipolar (B-TURP) techniques, with a subgroup analysis based on phosphodiesterase-5 inhibitor (PDE5i) use.

Materials and methods: This randomized clinical trial included candidates for TURP who were over 50 years old. Patients were divided into M-TURP and B-TURP groups. Erectile function was assessed using the International Index of Erectile Function-15 (IIEF-15) at baseline, six weeks, and six months post-surgery.

Results: A total of 205 patients were analyzed (102 in the M-TURP group and 103 in the B-TURP group). Both groups showed no significant differences in baseline characteristics, perioperative findings, or surgical complications. IIEF-15 scores were comparable between groups at all time points. In the PDE5i user subgroup, M-TURP showed a slight short-term decline in erectile function and total scores at 6 weeks, but both groups demonstrated no significant long-term changes in ED at 6 months.

Conclusion: While no significant difference was observed in the impact of M-TURP and B-TURP on erectile function during medium-term follow-up, patients with a history of PDE5i usage may experience fewer adverse effects on their erectile function from B-TURP during the short-term follow-up.