Validated Assessment of Ejaculatory and Erectile Function After Unilateral “Z”-Shaped Bladder Neck Incision (ZANCLE): A Prospective Study Using the MSHQ-EjD Short Form and IIEF-5

Background/Objectives: Preservation of anterograde ejaculation after transurethral incision for primary bladder neck obstruction (PBNO) has traditionally been assessed with unvalidated binary self-report. We prospectively evaluated ejaculatory and erectile function after the ZANCLE (“Z” Anatomical Needle Cut Leads Ejaculation) technique using two validated patient-reported outcome instruments, the Male Sexual Health Questionnaire–Ejaculatory Dysfunction Short Form (MSHQ-EjD-SF) and the International Index of Erectile Function-5 (IIEF-5). Methods: Forty consecutive patients undergoing ZANCLE for PBNO at a single institution were prospectively enrolled between June 2024 and July 2025. MSHQ-EjD-SF (ejaculatory function domain, items for force/volume/frequency, independent bother item) and IIEF-5 were administered at baseline and at 1, 6, and 12 months postoperatively, together with the binary anterograde-ejaculation question used in the parent cohort. Voiding parameters (Qmax, IPSS, PVR) are not described here, as they have already been reported for this technique by our group in a previously published series. Results: Median age was 41 years (IQR 35–55). The MSHQ-EjD-SF function domain score was unchanged from baseline to 12 months (10.8 ± 1.3 vs. 11.0 ± 1.1, Δ+0.2, p = 0.52), while the bother item improved significantly (1.1 ± 0.9 vs. 0.5 ± 0.6, Δ−0.6, p = 0.011). IIEF-5 total score remained stable throughout follow-up (20.1 ± 3.0 vs. 20.5 ± 2.8 at 12 months, Δ+0.4, p = 0.58). Anterograde ejaculation was preserved by binary self-report in 100% of evaluable patients at every postoperative timepoint. Conclusions: Validated instruments confirm, with greater granularity than binary self-report, that the ZANCLE technique preserves ejaculatory function domain scores and erectile function while reducing ejaculation-related bother. These preliminary findings support incorporation of MSHQ-EjD-SF and IIEF-5 into future prospective evaluations of ejaculation-sparing bladder neck surgery.