Ejaculatory dysfunction is the most common side effect related to surgical treatment of benign prostatic obstruction (BPO). Nowadays, modified surgical techniques and non-ablative techniques have emerged with the aim of preserving antegrade ejaculation. Our objective was to conduce a systematic review of the literature regarding efficacy on ejaculatory preservation of modified endoscopic surgical techniques, and mini-invasive non-ablatives techniques for BPO management.
A systematic review of the literature was carried out on the PubMed database using the following MESH terms: “Prostatic Hyperplasia/surgery” and “Ejaculation”, in combination with the following keywords: “ejaculation preservation”, “photoselective vaporization of the prostate”, “photoselective vapo-enucleation of the prostate”, “holmium laser enucleation of the prostate”, “thulium laser”, “prostatic artery embolization”, “urolift”, “rezum”, and “aquablation”.
The ejaculation preservation rate of modified-TURP ranged from 66 to 91%. The ejaculation preservation rate of modified-prostate photo-vaporization ranged from 87 to 96%. The only high level of evidence studies available compared prostatic urethral lift (PUL) and aquablation versus regular TURP in prospective randomized-controlled trials. The ejaculation preservation rate of either PUL or aquablation compared to regular TURP was 100 and 90 versus 34%, respectively.
Non-ablative therapies and modified endoscopic surgical techniques seemed to be reasonable options for patients eager to preserve their ejaculatory functions.
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Conflict of interest
Armand Chevrot: none. Nicolas Barry Delongchamps: none. Amin Benchikh: none. Jean Nicolas Cornu: none. Aurélien Descazeaud: consultant for Bouchara Recordati, Pierre Fabre Medicament, Lilly, investigator pour EDAP TMS. Steeve Doizi: none. Marc Fourmarier: consultant for GSK and EDAP TMS. Souhil Lebdai: none. Benjamin Pradère: none. Vincent Misraï: none. Gregoire Robert: consultant for Pierre Fabre Medicament, investigator for EDAP TMS. Pierre Etienne Theveniaud: none.
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Lebdai, S., Chevrot, A., Doizi, S. et al. Do patients have to choose between ejaculation and miction? A systematic review about ejaculation preservation technics for benign prostatic obstruction surgical treatment. World J Urol 37, 299–308 (2019). https://doi.org/10.1007/s00345-018-2368-6