Factors Predicting the Success of Ejaculation Preserving Transurethral Resection of the Prostate: A Prospective Cohort Study

: Objective To evaluate the clinical and anatomical factors predicting the preservation of antegrade ejaculation following ejaculation preserving transurethral resection of the prostate (EP-TURP). Methods This prospective cohort study included sexually active men undergoing EP-TURP. Preoperative evaluation included the International Prostate Symptom Score (IPSS), quality of life (QoL), and assessment of ejaculatory function using the Male Sexual Health Questionnaire–Ejaculatory Dysfunction Short Form (MSHQ-EjD-SF). Transrectal ultrasonography was used to evaluate prostate size, intravesical prostatic protrusion (IPP), supramontanal length (SML), and the presence of a median lobe. The surgical technique involved preserving 1 cm of circumferential urethral mucosa around the verumontanum while performing standard bipolar TURP. Patients were followed up at 3 months postoperatively. Multivariable regression analysis was used to identify predictors of ejaculation preservation. Results A total of 108 patients were included in the final analysis. Significant improvements were observed in postoperative voiding parameters (p < 0.001). Antegrade ejaculation was preserved in 63 patients (58.3%). Preservation was significantly higher in patients with prostate size <80 g compared with ≥80 g (81.1% vs 36.4%). On multivariable analysis, larger prostate volume (OR 0.97, 95% CI 0.95–0.99, p = 0.018), increased IPP (OR 0.75, 95% CI 0.56–0.99, p = 0.023), and the presence of a median lobe (OR 0.73, 95% CI 0.54–0.99, p = 0.048) were independently associated with a lower odds of ejaculation preservation Conclusions EP-TURP provides significant improvement in voiding parameters while preserving antegrade ejaculation in a substantial proportion of patients. Larger prostate size, significant intravesical prostatic protrusion, and median lobe enlargement are associated with lower preservation rates and should be considered during patient selection and preoperative counseling.