Ejaculatory dysfunction (ED) is a major cause of postoperative dissatisfaction, reducing orgasm intensity for 50% of patients and concerning about a third of those undergoing surgery. Ejaculation is a complex process involving several structures, especially the Veru Montanum, a key element located in the prostate resection zone. This study aims to investigate the biomechanics of ejaculation in healthy men using real-time imaging techniques.
This study is an interventional study, with prospective descriptive analysis on healthy volunteers. The sample size of the study was three participants. A Qualitative study of images and videos of imaging examinations was planned with: 1) Real time Transrectal ultrasound during ejaculation, for observation of the pre-, per- and post-ejaculatory phases. A real-time ultrasound examination of the prostate, posterior urethra, and bladder neck was performed using a SIEMENS ACUSON S2000 ultrasound system with a convex endocavitary probe (4.0–9.0 MHz). The volunteer was positioned laterally. 2) Real time Uretroscopy during ejaculation, for observation of the pre-, per- and post-ejaculatory phases. The second session 7 days later was performed involving a flexible 7.5 Fr ureteroscope to visualize anatomical structures during ejaculation. Ethical committee with ID RCB: 2022-A01594-39. ClinicalTrials .gov : NCT05650853.
Results of ultrasound image evaluation: Ultrasound evaluation of the prostate during sexual stimulation as well as during ejaculation allowed to highlight new elements related to the emission phase:
1. Creation of a peri-montanial cavity (called ‘Aphrodite’s antechamber’) under hyperpressure where the first millilitres of sperm from the ejaculatory ducts are concentrated.
2. No systematic closure of the bladder neck. Contraction of the periprostatic muscles.
and along the ejaculatory ducts contributing to the emission of sperm into Aphrodite’s antechamber.
New elements have also been demonstrated during the expulsion phase, such as the initial anterior tilt of the veru montanum (“Veru Kiss”), which ‘like a catapult’ allows the sperm to be expelled under high pressure. – Results of the evaluation of urethroscopic images : The evaluation enabled us to demonstrate for the first time, in the form of a video the reality of the perimontanal hyperpressure cavity in the emission phase. We were able to demonstrate the posterior closure of the cavity downstream of the bladder neck. The dilation of this perimontanal space thus creating the antechamber of Aphrodite.
This is the first study to highlight the role of a high-pressure area around the verumontanum, called the ‘Aphrodite antechamber.’ Understanding its dynamic role in the emission and expulsion phases will support the development of surgical techniques for ejaculation preservation and further exploration in patients with ejaculatory disorders.
