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Optimizing ejaculatory function after prostate resection: A stratified meta-analysis of anatomical preservation
Syah Mirsya Warli1,2, Satria Gohtama3
1Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara - Haji Adam Malik General Hospital, Medan, Indonesia.
Urologia
|May 28, 2026
Summary
Ejaculation-preserving (EP) prostate resection improves antegrade ejaculation preservation for benign prostatic obstruction (BPO) without compromising urinary or erectile function. Preserving only the peri-verumontanum offers similar benefits to wider preservation.
Area of Science:
- Urology
- Surgical Innovation
- Men's Health
Background:
- Benign prostatic obstruction (BPO) affects many men, often treated with prostate resection.
- Traditional resection techniques can negatively impact ejaculatory function.
- Ejaculation-preserving (EP) techniques aim to mitigate these side effects.
Purpose of the Study:
- To assess the impact of EP prostate resection on ejaculatory and urinary outcomes in BPO patients.
- To compare peri-verumontanum-only preservation with bladder-neck preservation for functional benefits.
Main Methods:
- A meta-analysis of randomized controlled trials (RCTs) adhering to PRISMA 2020 guidelines.
- Systematic literature search across major databases (PubMed, Cochrane, ScienceDirect) up to June 2025.
- Stratification of studies based on the extent of anatomical preservation (peri-verumontanum vs. bladder-neck).
Main Results:
- Analysis of 8 RCTs involving 580 patients.
- EP prostate resection demonstrated superior antegrade ejaculation preservation compared to standard resection.
- No significant difference in urinary or erectile outcomes was observed between EP and standard methods.
- Subgroup analysis indicated no additional functional benefit from extending preservation to the bladder neck.
Conclusions:
- EP techniques enhance antegrade ejaculation preservation while maintaining short-term urinary outcomes.
- Peri-verumontanum preservation alone seems functionally equivalent to broader preservation up to the bladder neck.
- Further large-scale, robust studies are needed to validate these exploratory findings.
