UNASSIGNED: Although conventional transurethral resection of the prostate (TURP) is highly successful in improving urinary symptoms and flow rates, a higher incidence of loss of antegrade ejaculation has been reported. Therefore, we aimed at prospectively comparing the efficacy and outcomes of a novel dual bladder neck and supramontanal sparing TURP to conventional TURP to improve voiding and ejaculation.
UNASSIGNED: Between January 2019 and November 2020, all patients with benign prostatic hyperplasia (BPH) satisfying the eligibility criteria underwent either conventional TURP (Group 1) or combined bladder neck and supramontanal sparing TURP (Group 2) after randomisation. The groups were compared for functional outcomes including International Prostate Symptom Score (IPSS), peak flow rates, post-void residual urine, perioperative variables and postoperative complications. Ejaculation was assessed with International Index of Erectile Function-Question 9 (IIEF-9) and Ejaculation Projection score (EPS).
UNASSIGNED: A total of 90 patients were randomised, 45 each to Group 1 and 2 respectively. The demographic profiles across both groups were comparable. Retrograde ejaculation and bladder neck contracture were significantly higher in Group 1. Both groups demonstrated significant improvement in the IPSS (26.12 ±2.88 to 4.69 ±0.87 (Group 1) vs 26.60 ±3.45 to 4.36 ±1.74 in Group 2) and Qmax (7.03 ±2.71 to 24.36 ±3.82 mL/s in Group 1 vs 6.29 ±2.64 to 25.28 ±4.33 mL/s in Group 2) at 3 months. However, a significant difference in IPSS and Qmax were recorded at 6 months. IIEF-9 score in Group 2 remained similar to preoperative profile (4.18 ±0.75) vs 2.58 ±0.86 (Group 1). EPS significantly decreased in Group 1 but remained similar to preoperative EPS in Group 2. Antegrade ejaculation was preserved in 88.89% in Group 2 as compared to 22.22% in Group 1.
UNASSIGNED: Dual bladder neck and supramontanal ejaculation preserving TURP is superior to conventional TURP in preventing retrograde ejaculation and bladder neck contractures in prostates <50 cc with comparable functional results, perioperative and postoperative morbidity.

OBJECTIVE: To review the current data on retrograde ejaculation (RE) and ejaculatory dysfunction (EjD) after endoscopic and minimally invasive surgical treatment of benign prostatic obstruction (BPO) and, their perceived impact in the quality of life (QoL) and sexual life of patients and their partners.
METHODS: Narrative review of systematic reviews (SR) assessing comparative rates of RE, EjD or erectile dysfunction (EF) was carried out. Relevant articles on the prevalence of RE, EjD or EF and on their impact in the QoL or sexual life of patients and partners were manually selected based on relevance.
RESULTS: Twelve SRs reporting on comparisons of different endoscopic/minimally invasive treatments of BPO were found. Data on outcomes varied widely. Overall, after conventional TURP or laser techniques 42-75% of patients present RE. Prostatic incision and ablative procedures present lowest rates of de novo RE or EjD whereas laser adenomectomy and ejaculation preservation procedures preserve antegrade ejaculation in 46-68% of patients. EjDs is associated to LUTS and present in 10% of sexualy active men before intervention. It modulates the QoL and sexual life of the couple. In spite of the scarce literature assessing patient\'s and partner\'s perception of postoperative EjD, it strongly suggests that both parties value the maintenance of the ejaculatory function.
CONCLUSIONS: Ejaculation-preserving techniques and minimally invasive techniques successfully prevent BPO treatment-induced RE or EjD in 70-100% of the cases. While this is appealing to patients and spouses, technique selection and treatment durability are issues to be discussed with the couple.