Ejaculatory Hood‐Sparing Photoselective Vaporization of the Prostate: A Retrospective Single‐Center Pilot Study Evaluating Ejaculation Preservation With Bladder Neck Opening

OBJECTIVES: To evaluate the feasibility, safety, and short-term functional outcomes of adding bladder neck opening and ventral adenoma vaporization to ejaculatory hood (EH)-sparing photoselective vaporization of the prostate (PVP), aimed at preserving antegrade ejaculation in patients with benign prostatic obstruction (BPO). METHODS: This retrospective, single-center pilot study included 27 patients with BPO who underwent PVP at our institution with the purpose of preserving ejaculatory function. EH was defined as the area within approximately 1 cm proximal and lateral to the verumontanum, which was preserved during bladder neck opening and ventral adenoma vaporization to create an unobstructed cavity from the prostatic apex to the bladder neck. The primary endpoint was the preservation of antegrade ejaculation at 3 months postoperatively. RESULTS: At 3 months postoperatively, 26 (96%) of 27 patients had preserved antegrade ejaculation, and one (4%) patient was suspected of retrograde ejaculation. The median International Prostate Symptom Score decreased from 21 to 7, and the quality-of-life score decreased from 5 to 2. Further, the maximum flow rate increased from 5.4 to 14.3 mL/s, and the postvoid residual urine volume decreased from 72.5 to 0 mL (all p < 0.001). The median prostate volume decreased from 60 to 24 mL, and Clavien-Dindo grade III or higher adverse events were not observed. CONCLUSIONS: EH-sparing PVP with bladder neck opening and ventral adenoma vaporization was feasible and safe in the short term and was associated with preserved antegrade ejaculation and improved urinary outcomes in patients with BPO. Further prospective studies with validated sexual function assessment and longer follow-up are necessary to confirm these findings.