Optimizing ejaculatory function after prostate resection: A stratified meta-analysis of anatomical preservation strategies.

In 30 seconds

This PRISMA-guided meta-analysis pooled eight randomized controlled trials involving 580 men with benign prostatic obstruction to assess ejaculation-preserving prostate resection versus standard resection and compare anatomical preservation strategies. Ejaculation-preserving techniques improved preservation of antegrade ejaculation while urinary and erectile outcomes were comparable. Subgroup analysis found no additional functional advantage when preservation extended from the peri-verumontanum to include the bladder neck. The authors characterize these findings as exploratory and call for confirmation in larger, methodologically robust studies.

Key findings

• Eight randomized controlled trials including 580 patients were analyzed.
• Ejaculation-preserving resection improved preservation of antegrade ejaculation compared with standard resection.
• Urinary and erectile outcomes were comparable between ejaculation-preserving and standard resection.
• Adding bladder-neck preservation to peri-verumontanum preservation showed no additional functional advantage.

Why it matters

Postoperative ejaculatory function is a relevant outcome when considering prostate resection for benign obstruction. This synthesis suggests that ejaculation-preserving approaches may better retain antegrade ejaculation without compromising reported urinary or erectile outcomes, while more extensive anatomical preservation did not show added functional benefit. The findings remain exploratory, so the evidence does not establish which preservation strategy is preferable.

What to keep in mind

The authors describe the findings as exploratory and call for validation in larger, methodologically robust studies. The abstract reports comparable short-term urinary outcomes but provides no follow-up duration or quantitative effect estimates.