Ejaculation Sparing Bladder Neck Incision for Young Men With Primary Bladder Neck Obstruction

To evaluate clinical and ejaculatory outcomes following ejaculation-sparing bladder neck incision (ESBNI) in young men with primary bladder neck obstruction (PBNO).

Retrospective cohort study with prospective outcome assessment of men ≤ 40 years who underwent ESBNI between 2022 and 2025 for videourodynamically confirmed PBNO. All patients underwent a single bladder neck incision at the 6 o'clock position using standard electrocautery, with distal extent limited to approximately 10 mm proximal to the verumontanum. Ejaculatory outcomes were assessed using the Male Sexual Health Questionnaire-Ejaculatory Dysfunction Short Form (MSHQ-EjD-SF). The primary outcome was preservation of the ability to ejaculate (score ≥ 4 on Question 1). Secondary outcomes included ejaculatory function (sum of Questions 1-3), postoperative maximum flow rate (Q_max), and other key clinical outcomes including complications. Non-parametric statistical tests were used.

At a median follow-up of 13 months, antegrade ejaculation was preserved in 100% of patients with available data (51/53), and 90% demonstrated normal ejaculatory function. Median postoperative Q_max was 17 mL/s, with 67% and 27% achieving normal (≥ 15 mL/s) and borderline flow (12-14 mL/s), respectively. Among catheter-dependent patients, 18/19 became catheter-free. In catheter-independent patients, median improvement in Q_max was 9 mL/s. Higher Bladder Outflow Obstruction Index and Detrusor Contraction Index (ICS-DCI) were associated with improved postoperative flow, while ejaculatory function was positively associated with DCI. Three patients required redo surgery. Complications were minimal.

Ejaculation-sparing bladder neck incision is a safe and effective surgical option for young men with videourodynamically-confirmed PBNO, providing meaningful improvement in urinary flow with reliable preservation of ejaculation.