Alterations in sexual function and sexual quality of life during management of benign prostatic hyperplasia (BPH) may not have been adequately considered by urologists in the past. The increasing spectrum of novel technologies that allow ablation of prostatic tissue has changed the landscape for management of lower urinary tract symptoms (LUTS). The effect of medical therapy, especially the use of selective alpha blockers, on emission and antegrade ejaculation has enhanced the likelihood of patient acceptance of new minimally invasive surgical interventions for BPH.
Increased recognition of changes in sexual function, including normal ejaculation after surgical treatment, is an important factor in patient choice of BPH treatments. Previously, preservation of erectile function was the most important sexual consideration in management of BPH. Now, there is an increasing focus on maintenance of antegrade ejaculation as well. The exact mechanisms for maintenance of antegrade ejaculation during extirpative treatment of BPH have not been completely delineated. It is clear that a competent bladder neck is important, as well as preservation of the verumontanum structures containing the ejaculatory ducts, and possibly the immediate surrounding tissues.
Although many articles could be referenced for their critical contributions to our understanding of the effects of surgical therapy on sexual function, this recent systematic review brings together substantive data from multiple understandings to help urologists in their management of men who are concerned about preservation of normal sexual function, especially antegrade ejaculation, with treatment of BPH.
This article overviews the results after treatment with a wide variety of different interventions. The authors conclude that interventions with novel minimally invasive surgical therapies can yield fast and effective relief of LUTS without adversely affecting patients’ quality of life. The review recognizes that only Rezūm, UroLift, and prostate arterial embolization procedures had a minimal impact on patients' sexual function relative to baseline, especially regarding preservation of ejaculation. This review contains valuable information that many of our patients are keenly interested in understanding prior to making a decision about new minimally invasive surgical prostate treatments.