Incidence of Erectile Dysfunction After TURP for BPH
The incidence of erectile dysfunction after TURP for benign prostatic hyperplasia ranges from 7-13%, with the most robust guideline data reporting 10% based on randomized controlled trials. 1
Guideline-Based Incidence Rates
The 2003 AUA guideline on BPH management, using RCT data with TURP controls, reports erectile dysfunction occurs in 10% (95% CI: 7-13%) of patients after TURP. 1 This represents the highest quality evidence from controlled trials and should be considered the reference standard for counseling patients.
More recent guideline updates confirm similar rates:
- The 2018 AUA guideline reports ED rates of 11.5% after TURP when compared to other modalities like TUMT (6.3%). 1
- The 2023 European Association of Urology guideline acknowledges ED as a recognized complication of TURP, though specific incidence rates align with the 7-13% range. 1
Research Evidence on ED Incidence
Individual studies provide more granular data on ED incidence after TURP:
14% incidence in a prospective study of 63 patients using objective nocturnal penile tumescence measurements at 3 months post-TURP. 2 This study used rigorous inclusion criteria (IIEF-5 >16 preoperatively) and objective NPT parameters.
12% incidence of newly-reported ED at 6 months in a large series of 459 patients who had normal erectile function preoperatively. 3 This study from a high-volume center (>500 patients) provides robust real-world data.
5.8% worsening of erectile function among patients with good preoperative erectile function in a retrospective study of 264 patients. 4
Age-dependent incidence: In patients with normal preoperative IIEF-5 scores (≥22), the IIEF-5 score decreased significantly at 12 months, with age being the only independent risk factor. 5
Key Risk Factors for Post-TURP ED
Age is the most consistently identified independent risk factor for developing ED after TURP:
- Patients older than 65 years have significantly higher risk of developing ED after TURP compared to younger patients. 5
- Advanced age was consistently associated with increased risk of ED across multiple studies. 2, 3, 5
Diabetes mellitus is a significant independent risk factor for post-TURP ED:
- Identified as significant in multiple studies (p=0.003 in one large series). 3
- Diabetic patients had higher rates of ED development post-TURP. 2
Intraoperative capsular perforation increases ED risk:
- Associated with newly reported ED after TURP (p=0.02). 3
Clinical Context for Your Patient
For your patient with hypertension managed with perindopril and indapamide, the baseline ED risk from TURP remains 10% (7-13%) based on guideline data. 1 However, consider these additional factors:
- Hypertension itself was not found to be a statistically significant risk factor for post-TURP ED in research studies. 5
- ACE inhibitors (perindopril) and thiazide-like diuretics (indapamide) can independently contribute to ED, though this is separate from the surgical risk.
- The patient's age will be the primary determinant of ED risk after TURP, with significantly higher risk if >65 years. 5
Important Counseling Points
When counseling patients about ED risk after TURP:
- Ejaculatory dysfunction is far more common than erectile dysfunction, occurring in 65% (56-72%) of patients after TURP. 1 This represents retrograde ejaculation and should be distinguished from ED.
- Some patients with preoperative mild-to-moderate ED may actually experience improvement in erectile function after TURP (16.2% in one study), likely due to relief of LUTS and improved quality of life. 4
- Psychological factors play an important role in post-TURP sexual function and should be addressed both preoperatively and postoperatively. 4
Comparison to Alternative Procedures
If preservation of erectile function is a priority, consider discussing alternative procedures with lower ED rates: