Ejaculatory-projective techniques in the surgical treatment of benign prostatic hyperplasia

Introduction. Retrograde ejaculation (RE) has many well-described causes, ranging from pharmacological disturbances to interference with innervation mechanisms during surgical treatment of benign prostatic hyperplasia (BPH).

Objective. To explore the anatomical and physiological aspects of retrograde ejaculation (RE) and to critically evaluate published evidence regarding the preservation of antegrade ejaculation following various ejaculatory-sparing procedures, drawing on the latest medical literature.

Materials & Methods. A comprehensive literature search was performed across PubMed, MEDLINE, and Scopus databases for the period 1966–2024. Differential searches employed the keywords «benign prostatic hyperplasia», «retrograde ejaculation», «ejaculatory-protective techniques», «transurethral enucleation», «assessment of ejaculatory disorders», and «physiology of ejaculation». In total, 1126 sources were screened, with 51 articles included for review.

Results. The main perspectives on the anatomo-physiological basis of RE were identified, alongside the subjective methods used to assess ejaculatory disorders. Additionally, current ejaculatory-protective techniques and alternative surgical approaches for the treatment of BPH were highlighted. Advances in high-tech medical care for BPH have already provided patients undergoing transurethral procedures with the possibility of fathering children. Consequently, patient expectations today extend beyond mere symptom relief to include improved psycho-emotional wellbeing and enhanced quality of life in social aspects.

Conclusion. Implementation of ejaculatory-sparing surgical techniques markedly improves the psychosocial outcomes and overall quality of life for patients treated for BPH. Continued investigation into the mechanisms of RE, as well as the refinement of surgical methods, is warranted to further mitigate this complication and optimize patient-centred care.

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