(044) Assessment of Ejaculation Status and Ejaculation Sparing Techniques in Laser Enucleation of the Prostate: A Systematic Review

Introduction Techniques are being developed to make laser enucleation of the prostate (LEP) easier and improve postoperative functional outcomes. One of the main challenges of benign prostatic obstruction (BPO) surgery is retrograde ejaculation. According to research on the physiology of ejaculation, the tissues surrounding the verumontanum are crucial for outward ejaculation. Surgical methods that preserve tissue in the paracollicular and supramontanal regions have been developed, markedly affecting postoperative quality of life. A comprehensive synthesis of these ejaculation-sparing (ES) strategies has not been previously established. Objective This systematic review aimed to evaluate the rates of retrograde or antegrade ejaculation after LEP surgery for BPO, and the results of ES surgery. Methods A systematic search was conducted in PubMed, Embase, and the Cochrane Library using predefined MeSH and keyword terms for benign prostatic obstruction, laser enucleation, and ejaculation preservation. We included LEP studies in men with BPO reporting postoperative ejaculation outcomes, with or without ES approaches, following PRISMA 2020. The primary outcome was the rate of antegrade ejaculation preservation, and the secondary outcome was change in MSHQ-EjD scores. Results Twenty-five studies met inclusion criteria. Because of heterogeneity across control groups (standard HoLEP, TURP, Rezum, B- TUEP) and ES definitions, meta-analysis was not feasible. Twenty studies reported postoperative ejaculation rates, and five assessed MSHQ-EjD outcomes. A pooled analysis of ten comparative studies showed antegrade ejaculation in 371/625 (59.4%) LEP vs 387/588 (65.8%) controls (p = 0.9). Two studies comparing MSHQ-EjD function found no significant difference (p = 0.96). Qualitatively, antegrade ejaculation rates were 71–88%, 64–94%, and 46–94% at 3, 6, and 12 months, respectively. ES-LEP preserved or improved antegrade ejaculation without increasing retrograde risk. Conclusions ES-LEP techniques maintain antegrade ejaculation and functional outcomes with comparable safety. Anatomical dissection around the verumontanum yields consistent results. Integrating ES principles into LEP may improve postoperative sexual satisfaction, particularly for younger, sexually active patients. Disclosure No