Standardized technique for ejaculation preservation during prostatic endoscopic ablative surgery.

Area of Science:

• Urology
• Surgical Techniques
• Sexual Medicine

Background:

• Ejaculatory dysfunction is a common complication following surgery for benign prostatic hyperplasia (BPH).
• Current surgical techniques for BPH often compromise antegrade ejaculation.
• There is a need for standardized, validated surgical methods that preserve ejaculation while effectively relieving obstruction.

Purpose of the Study:

• To define an ideal surgical technique for BPH that achieves both effective obstruction relief and preservation of antegrade ejaculation.
• To establish consensus among investigators of the PARTURP randomized study on the specific anatomical landmarks and criteria for ejaculation-sparing prostate resection.

Main Methods:

• An expert consensus meeting utilizing the nominal group methodology was conducted with all 15 investigators of the PARTURP study.
• The meeting focused on defining critical areas for resection and preservation during surgery.
• Criteria for assessing successful obstruction relief and ejaculation preservation were established.

Main Results:

• Unanimous agreement was reached among all 15 investigators on the surgical technique.
• Key anatomical landmarks for preservation include the area around the verumontanum and the posterior prostatic urethra, extending up to 2 cm from the verumontanum.
• Preservation of urethral mucosa in designated areas and achieving the correct enucleation plane were agreed upon.

Conclusions:

• Specific anatomical landmarks for performing ejaculation-sparing surgery in BPH patients have been successfully defined through expert consensus.
• These defined landmarks will guide the surgical procedures within the PARTURP randomized study.
• The study will compare the clinical outcomes of this ejaculation-sparing technique against complete prostate resection over a 3-year follow-up period.