Affective disorders before and after laser enucleation of the prostate

Introduction. Lower urinary tract symptoms (LUTS), sexual dysfunction and psychological disorders coexist in the lives of older men. Evaluation of the prevalence of mood disorders and sexual dysfunction after surgical treatment is important to ensure a high quality of life for patients with LUTS.

Objective. To analyse the incidence and severity of affective disorders in patients before and after laser enucleation of the prostate and to determine their association with LUTS and erectile dysfunction.

 Materials & methods. The study included 136 patients with benign prostatic hyperplasia treated with laser enucleation between 2018 and 2023. All the male participants were sexually active, and their erectile function was assessed at 11 points or higher according to the IIEF-5 scale. In addition to standard examination methods, all patients completed the IPSS, IIEF-5, and HADS questionnaires prior to surgery and 18 months postoperatively. The first stage of the study involved an investigation into the prevalence and severity of affective disorders both before and after surgical intervention, as well as determining their correlation with LUTS. The second stage focused on examining the relationship between affective disorders and sexual dysfunction. Patients were categorized into two groups based on the absence or presence of negative influence of LUTS on their quality of sexual life: group 1 (n = 70) — no influence, group 2 (n = 66) — influence is present.

Results. Anxiety and depressive disorders of varying severity were found in 48 (35.3%) and 46 (33.8%) patients, respectively. It was found that the severity of both anxiety (r = 0.574; p < 0.001) and depressive disorders before surgical treatment correlated with LUTS (r = 0.590; p < 0.001), but after surgical treatment only anxiety disorder scores had a correlation with LUTS (r = 0.742; p < 0.001), and with irritative symptoms (r = 0.475; p < 0.001). Group 2 patients had lower IIEF-5 scores (18.0 vs. 21.0 points; p < 0.001) and were more likely to have anxiety and depressive disorders before surgical treatment (45.7 and 44.3% vs. 22.8 and 22.7%; p < 0.05), with significant improvement in erectile function and affective status after surgery, in contrast to group 1 patients, whose IIEF-5 scores and incidence of affective disorders did not change significantly.

Conclusion. Patients with a predominantly irritative LUTS profile and a negative impact of urinary disturbances on sexual life are more susceptible to anxiety and depressive disorders. Consequently, evaluating their affective state is essential when treating men with LUTS to enhance their quality of life.

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