Surgical management of benign prostatic hyperplasia (BPH) effectively improves urinary symptoms and flow rates when medical therapy fails. Loss of antegrade ejaculation and sexual function remains a major drawback. Ejaculation-sparing techniques employ modifications to traditional transurethral resection, vaporization or enucleation to preserve the paracollicular tissue and ejaculatory duct region near the verumontanum as well as a mucosal bridge at 6 o’clock. These have emerged as a promising strategies to maintain sexual function. We evaluated the efficacy at conserving forward ejaculation in ejaculation-sparing approaches in BPH surgeries compared to the standard techniques.
A systematic search of PubMed, Embase, and Scopus databases was performed to identify randomized and non-randomized studies comparing ejaculation-sparing versus standard techniques for BPH surgery. Studies were stratified based on BPH surgery for subgroup analyses. The primary outcome was preservation of antegrade ejaculation. Secondary outcomes included International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF), maximum urinary flow rate (Qmax), operative time, and length of stay (LOS). Results were expressed as odds ratios (OR) and mean differences (MD), with 95% confidence intervals.
Fourteen studies (7 randomized and 7 non-randomized) including 1,259 patients were analyzed; 589 underwent ejaculation-sparing surgery and 670 underwent standard surgery. Nine studies provided data on antegrade ejaculation. Preservation of antegrade ejaculation was significantly higher in the ejaculation-sparing group (OR 5.24, 95% CI 2.42-11.31; p<0.001;Figure 1). The ejaculation-sparing group also demonstrated shorter operative time (MD -6.08 min, 95% CI -10.06, -2.10; p=0.002). Qmax change at 3 months favored the standard technique (MD 0.64, 95% CI 0.03-1.26), but no difference was observed at 6 months. There were no significant between-group differences in LOS, IIEF, or IPSS change at 6 months.
This meta-analysis demonstrated that ejaculation-sparing surgery provided superior preservation of antegrade ejaculation without compromising urinary function outcomes.
No funding was received
