Ejaculatory Hood–Sparing Holmium Laser Enucleation of the Prostate

Introduction:

Retrograde ejaculation is a frequent consequence of endoscopic prostate surgery and can impact patient satisfaction. Techniques designed to preserve ejaculation during holmium laser enucleation of the prostate (HoLEP) may positively affect antegrade ejaculation; however, these methods have not been previously evaluated. This study aimed to assess the functional outcomes of the ejaculatory hood-sparing technique in HoLEP.

Method and Technique:

We performed a retrospective cohort study of men treated with HoLEP by a single surgeon. Patients underwent either ejaculatory hood–sparing HoLEP, preserving a small transitional-zone cuff at the level of the verumontanum, or standard HoLEP. The ejaculation-preserving technique is demonstrated in the accompanying video. Collected data included patient demographics, prostate volume, pre- and postoperative International Prostate Symptom Score (IPSS), duration of follow-up, and postoperative ejaculatory status. The primary outcomes were preservation of antegrade ejaculation and change in IPSS. Fisher’s exact test and the Mann–Whitney U test were used for between-group comparisons.

Results:

Among 79 patients, 43 underwent ejaculatory hood–sparing HoLEP and 36 underwent standard HoLEP. The two groups were comparable in age (62 ± 6.9 vs. 65 ± 7.6 years) and prostate volume (82 ± 45 vs. 106 ± 55 cm³; p > 0.05). Preservation of antegrade ejaculation was significantly more frequent in the ejaculatory hood–sparing group (34/43, 79%) compared with the standard HoLEP group (8/36, 18%; p = 0.0006). Both groups demonstrated significant postoperative IPSS improvement (p < 0.001 each), with a median IPSS reduction of 17.6 points in the ejaculation-sparing group and 12.4 points in the standard group, without a significant between-group difference.

Conclusions:

Ejaculatory hood–sparing HoLEP significantly improved preservation of antegrade ejaculation compared with standard HoLEP while maintaining comparable improvement in lower urinary tract symptoms. This technique represents a viable option for men who prioritize preservation of ejaculatory function.

No competing financial interests exist.

No funding was received for this article.