Clinical Report: Ejaculatory Preservation in HoLEP vs Conventional HoLEP Outcomes

Overview

This randomized prospective study compared Ejaculatory Preservation (EP) HoLEP with standard HoLEP in patients with benign prostatic hyperplasia (BPH). The EP HoLEP technique demonstrated improved preservation of antegrade ejaculation and early postoperative continence without compromising lower urinary tract symptom relief.

Background

Holmium Laser Enucleation of the Prostate (HoLEP) has become a standard surgical treatment for benign prostatic hyperplasia (BPH) since its introduction in 1998. Despite its efficacy, complications such as transient urinary incontinence and retrograde ejaculation remain common. Recent surgical modifications aim to preserve ejaculatory function by protecting key anatomical structures like the musculus ejaculatorius and bladder neck mucosa. This study investigates the impact of an Ejaculatory Preservation (EP) HoLEP technique on postoperative continence and ejaculation compared to conventional HoLEP.

Data Highlights

Key Findings

• The EP HoLEP technique preserves approximately 10mm proximal to the verumontanum and mucosal strips at specific bladder neck positions to maintain ejaculatory function.
• Patients undergoing EP HoLEP showed a significantly lower rate of retrograde ejaculation compared to standard HoLEP.
• Early postoperative urinary continence rates were better in the EP HoLEP group, as measured by ICIQ-UI SF at 1 and 3 months.
• Both groups experienced similar improvements in lower urinary tract symptoms, including IPSS and Qmax.
• Sexual function, assessed by IIEF-5, was preserved in both groups, with no significant decline postoperatively.
• Perioperative adverse events were comparable between groups, indicating the safety of the EP HoLEP technique.

Clinical Implications

The EP HoLEP technique offers a valuable surgical modification to reduce the incidence of retrograde ejaculation and improve early urinary continence without compromising symptom relief in BPH patients. Surgeons should consider preserving key anatomical structures during HoLEP to enhance postoperative quality of life, particularly in sexually active men. This approach may optimize patient satisfaction and functional outcomes following prostate enucleation.

Conclusion

Ejaculatory Preservation HoLEP is a feasible and effective alternative to conventional HoLEP, providing superior preservation of antegrade ejaculation and early continence while maintaining comparable improvements in urinary symptoms. This technique represents a meaningful advancement in the surgical management of BPH.

References

1. Gilling et al. 1998 -- Introduction of Holmium Laser Enucleation of the Prostate (HoLEP)
2. Studies on UI and RE rates post-HoLEP
3. Research on musculus ejaculatorius role in ejaculation preservation
4. Ethical approval and study design details (ZU-IRB No. 9938)