OBJECTIVE: 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.
METHODS: 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\".
RESULTS: 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.
CONCLUSIONS: Non-ablative therapies and modified endoscopic surgical techniques seemed to be reasonable options for patients eager to preserve their ejaculatory functions.