Obstructive sleep apnea (OSA), lower urinary tract symptoms (LUTS), and erectile dysfunction (ED) are chronic conditions that seriously affect middle-aged men. This study aimed to evaluate the changes in the presence of these conditions after transoral robotic surgery (TORS) for OSA. This prospective observational study recruited 48 men with moderate-to-severe OSA (mean age 40.6 ± 8.1 years) who underwent TORS from October 2019 to November 2021 at a tertiary center. Baseline polysomnographic parameters, Epworth Sleepiness Scale (ESS), and demographic characteristics were measured. The evaluations of LUTS and ED were based on self-administered International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF-5) questionnaires, respectively, before TORS. The treatment outcomes were assessed three months postoperatively in the patients undergoing TORS due to moderate-to-severe OSA. There was significant Apnea-Hypopnea Index (AHI) reduction from 53.10 ± 25.77 to 31.66 ± 20.34 three months after undergoing TORS (p < 0.001). There was also a significant decrease in the total IPSS score (5.06 ± 5.42 at baseline to 2.98 ± 2.71 at three months postoperatively, p = 0.001), the storage domain, and the voiding domain (p < 0.05). The ED also improved significantly, as seen in the IIEF score (20.98 ± 3.32 to 22.17± 3.60, p = 0.007). The reduction of AHI was associated with changes in body weight and the lowest oxygen saturation (SpO₂) levels during sleep (rho = 0.395, p = 0.005; rho = 0.526, p < 0.001, respectively). However, the reduction in AHI was not significantly associated with improvement in IPSS or IIEF scores (p > 0.05). For men with moderate-to-severe OSA, TORS can significantly improve the polysomnography parameters, sleep-related questionnaire scores, and quality of life, and alleviate ED and LUTS. AHI reduction is not a crucial factor for ED and LUTS improvement after TORS for OSA, especially in ED.

Background: Benign prostatic hyperplasia (BPH) can be associated with lower urinary tract symptoms (LUTS) and potential avlterations in autonomic nervous system function, as reflected by heart rate variability (HRV). This observational study was designed to generate hypotheses regarding the differential impacts of surgical de-obstruction versus uroselective pharmacological blockade on autonomic nervous system equilibrium, HRV restoration, and symptomatic outcomes in men with BPH and bladder outlet obstruction. Methods: Data from a prospective cohort of 242 men undergoing TURP and 210 men receiving tamsulosin were analyzed. HRV parameters (standard deviation of normal-to-normal intervals [SDNN], low-frequency/high-frequency [LF/HF] ratio, total power [TP], very low frequency [VLF]) and International Prostate Symptom Score (IPSS) was assessed at baseline and 12 weeks. Propensity score matching (PSM) was used to address baseline differences in age, prostate volume, IPSS, and baseline SDNN. Inter-group comparisons used ANCOVA with baseline as a covariate. Results: After TURP, SDNN increased by 14.70 ms (40%; 36.97 ± 22.80 to 51.67 ± 27.59 ms; p = 0.032; paired Cohen’s d = 0.58), LF/HF decreased by 0.90 (55%; 1.63 ± 1.60 to 0.73 ± 0.52; p = 0.028; d = −0.76), TP increased by 1303 ms² (95%; 1367 ± 820 to 2670 ± 1420 ms²; p = 0.025; d = 1.12), and VLF increased by 810 ms² (85%; 950 ± 560 to 1760 ± 980 ms²; p = 0.030; d = 1.01). For tamsulosin, SDNN increased by 6.73 ms (18%; 38.12 ± 12.50 to 44.85 ± 11.20 ms; p = 0.004; d = 0.57), LF/HF decreased by 0.16 (8%; 1.95 ± 0.65 to 1.79 ± 0.55; p = 0.012; d = −0.27), TP increased by 559 ms² (39%; 1453 ± 620 to 2012 ± 580 ms²; p = 0.006; d = 0.93), and VLF increased by 355 ms² (35%; 1020 ± 450 to 1375 ± 420 ms²; p = 0.010; d = 0.82). Secondary p-values (LF/HF, TP, VLF) were adjusted via the Benjamini–Hochberg method; adjusted p > 0.05 was used for some. Inter-group differences in changes were significant (ANCOVA p < 0.01; partial η² = 0.12–0.22 for group factor). TURP was associated with greater IPSS reduction (−10.2 points; 18.5 ± 6.2 to 8.3 ± 4.1; p < 0.001) compared to tamsulosin (−5.3 points; 15.8 ± 5.6 to 10.5 ± 4.8; p < 0.001; d = −1.02; inter-group p < 0.001). PSM confirmed these associations with p < 0.01 for HRV changes. Change in SDNN was associated with IPSS improvement in multivariate regression (standardized β = −0.42, p < 0.01). Conclusions: In this observational study, TURP was associated with greater changes in HRV parameters and symptomatic improvement compared to tamsulosin. These findings are hypothesis-generating and require confirmation in long-term randomized trials.