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Ejaculatory disorders (EjD) affect nearly half of men with benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS). Preserving peri-montanal tissue during surgery is crucial for maintaining antegrade ejaculation.

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Area of Science:

  • Urology
  • Sexual Medicine
  • Men's Health

Background:

  • Benign prostatic hyperplasia (BPH) commonly causes lower urinary tract symptoms (LUTS) in men over 50.
  • Ejaculatory disorders (EjD) often accompany LUTS but are frequently overlooked.
  • This review details BPH-related EjD and their management.

Purpose of the Study:

  • To review the pathophysiology, epidemiology, evaluation, and treatment of BPH-related EjD.
  • To analyze the impact of medical, surgical, and interventional therapies on EjD.
  • To highlight the importance of initial EjD evaluation.

Main Methods:

  • Conducted a narrative review of publications from 1990-2020.
  • Focused on studies concerning BPH-related EjD.
  • Included research on physiopathology, epidemiology, evaluation, and therapeutic management.

Main Results:

  • 46% of men with LUTS reported EjD; prevalence increases with LUTS severity.
  • Medical therapies (alpha-blockers, 5-ARIs) can cause anejaculation or retrograde ejaculation (RE).
  • Surgical treatments vary in RE rates (TURP: 50-70%, TUIP: 21-35%, AEEP: 11-36%); newer techniques and tissue preservation show promise.

Conclusions:

  • EjD affects nearly half of BPH-LUTS patients and requires initial evaluation.
  • Preservation of peri-montanal tissue is key to maintaining antegrade ejaculation post-surgery.
  • Emerging surgical techniques offer better preservation of antegrade ejaculation.