Ejaculatory Dysfunction and Minimally Invasive Surgical Treatments (MIST) for Male Lower Urinary Tract Symptoms Secondary to Benign Prostatic Enlargement

While transurethral resection of the prostate (TURP) is considered the standard surgical treatment in symptomatic benign prostatic enlargement (BPE) secondary to benign prostatic hyperplasia (BPH), it is not without surgical morbidities and has adverse impact on various sexual function domains such as ejaculatory dysfunction (EjD) and erectile dysfunction (ED). This article evaluates the relationship between BPH/BPE and EjD in three relevant areas, namely (1) ejaculation and prostate gland, (2) an overview of the current MISTs with specific emphasis on EjD and (3) the role of tadalafil and pelvic floor exercises on ED and EjD. A PubMed review on peer‐reviewed, English‐language articles published in the last 15 years pertaining to BPH/BPE, related treatments and EjD was undertaken. The presence of BPE/BPH can distort the ejaculatory ducts with ensuing underlying neurovascular dysfunction and tissue inflammation, causing the development and progression of LUTS, while psychological distress from BPE/BPH symptoms can amplify ED and EjD. Medications and TURP can adversely impact ejaculatory function. The use of tadalafil and targeted pelvic floor exercises can safeguard and potentially improve ejaculatory function in men with urinary symptoms. Minimally invasive surgical therapies (MISTs) are effective and safe alternatives to TURP that can preserve sexual function postoperatively. BPE/BPH and sexual function are closely linked. Tadalafil and targeted pelvic floor exercises can safeguard and potentially improve ejaculatory function in men with urinary symptoms. MISTs are effective and safe alternatives to TURP that can preserve sexual function postoperatively and specifically EjD.