Evaluation of a novel technique of bladder neck and supramontanal sparing ejaculatory preserving transurethral prostatectomy

Abstract

Purpose

Transurethral resection of the prostate (TURP) can achieve highly satisfying symptomatic and functional outcomes but the loss of antegrade ejaculation represents a major reason for the avoidance of surgical treatment to preserve normal ejaculation and paternity. We present a novel technique to duplicate both bladder neck sparing and supramontanal sparing with resection of apical tissues to improve voiding and antegrade ejaculation.

Methods

A prospective study done from June 2018 to June 2020 on 60 consecutive male patients with normal sexual activity diagnosed with benign prostatic enlargement. These patients were randomized into two groups; 30 patients in each group. Group 1 underwent bladder neck and supramontanal sparing ejaculatory preserving transurethral bipolar resection of prostate (ep-TUBRP) and Group 2 underwent classic transurethral bipolar resection of prostate (c-TUBRP). All patients were evaluated pre- and postoperatively (after 3 months) using IPSS, Qmax and by IIEF-5.

Results

In both groups, there were significant improvements 3 months postoperative in Qmax [7.97 mL/s to 18.47 mL/s (group A) and 7.8 to 20.7 mL/s (group B)] and in micturition symptoms according to reductions in IPSS score [24 to 7.5 (group A) and 25 to 8.5 (group B)]. IIEF-5 score improved significantly from a mean of 12.9 to 18.6 (group A) and from 11.6 to 16.4 (group B). Antegrade ejaculation reported in 80% of patients in group A and 27% in group B which was significant (p < 0.001). Postoperative period did not reveal acute urinary retention, stress urinary incontinence, or serious adverse events.

Conclusions

On short-term results, bladder neck and supramontanal ejaculation preserving transurethral bipolar resection of the prostate is superior to classic TURP in preservation of forward ejaculation with comparable efficacy in micturition parameters.

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Fig. 1

Abbreviations

BOO:

Bladder outlet obstructions

BPO:

Benign prostate obstruction

BPH:

Benign prostatic hyperplasia

c-TUBRP:

Classic transurethral bipolar resection of prostate

ep-TUBRP:

Ejaculation-preserving transurethral bipolar resection of prostate

IIEF-5:

International Index of Erectile Function-5

IPSS:

International Prostate Symptoms Score

HoLEP:

Holmium laser enucleation of the prostate

Qmax:

Maximum flow rate

ThuLEP:

Thulium laser enucleation of the prostate

TURP:

Transurethral resection of prostate

TUIP:

Transurethral incision of the prostate

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Affiliations

Authors

Contributions

M. Elshazly: Surgical procedure. S. Sultan: Protocol development. M. Shaban: Data Collection. F. Zanaty: Manuscript writing and data analysis.

Corresponding author

Correspondence to Fouad Zanaty.

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Conflict of interest

None.

Research involving human participants and/or animals

The study was approved by Menoufia university—Faculty of medicine ethics committee. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

The study protocol was approved by our local ethical committee. All participants signed written informed consent before inclusion in the study.

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Elshazly, M., Sultan, S., Shaban, M. et al. Evaluation of a novel technique of bladder neck and supramontanal sparing ejaculatory preserving transurethral prostatectomy. World J Urol (2021). https://doi.org/10.1007/s00345-021-03752-z

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Keywords

  • Ejaculatory preserving
  • Bladder neck preserving
  • Supramontanal Sparing
  • Prostatectomy