ERECTILE DYSFUNCTION FOLLOWING ND-YAG VISUAL LASER-ASSISTED PROSTATECTOMY (VLAP)

We investigated if side fire Nd-YAG visual laser prostatectomy (VLAP) causes erectile dysfunction (ED) in patients who were sexually active prior to the procedure. The 36 study patients gave a detailed medical/ sexual history: physical examination included bulbo-cavernous reflex ( BCR) on rectal examination and routine blood tests. Lasing time, power of the applied laser beam (in watts), coagulation site and energy int ensity were recorded. Patients with new onset ED during the one year s tudy period underwent pudendal nerve conduction (PNC), color duplex Do ppler ultrasonography, and NPT/RigiScan testing. In 6 out of 36 (16.7% ) patients reporting significant post-operative ED, there was a tenden cy towards higher energy applied and longer lasing time but no correla tion between prostate size or the site of energy application. Patients reported loss of night and/or morning erections (n = 5), retrograde e jaculations (n = 2), loss of ejaculate (n = 2), and decreased sensatio n of orgasm (n = 3). Three had abnormal PNC, duplex Doppler showed abn ormal blood supply in four, and all six had abnormal NPT/RigiScan. We believe this is the first demonstration that VLAP may be associated wi th a high rate of ED and that the lasing time and intensity of applied laser energy may play a role in this outcome.