Ejaculation-Preserving Versus Standard Bipolar TUEP for BPH

Benign prostatic hyperplasia is a common cause of lower urinary tract symptoms in aging men. Surgical treatment is indicated when medical therapy fails or when symptoms remain bothersome. Bipolar transurethral enucleation of the prostate is an established endoscopic surgical technique for benign prostatic obstruction, but standard endoscopic prostate surgery may be associated with loss of antegrade ejaculation.

This study will evaluate whether an ejaculation-preserving modification of bipolar transurethral enucleation of the prostate can preserve ejaculatory function while maintaining effective relief of lower urinary tract symptoms. The ejaculation-preserving technique will preserve the paracollicular tissue, the area approximately 1 cm proximal to the verumontanum, and bladder neck fibers, while avoiding deep enucleation behind the verumontanum. The control group will undergo standard bipolar transurethral enucleation of the prostate.

Eligible sexually active men with benign prostatic hyperplasia and lower urinary tract symptoms after failed medical treatment will be randomized in a 1:1 ratio to ejaculation-preserving B-TUEP or standard B-TUEP. Sexual and urinary outcomes will be assessed using validated questionnaires and objective urinary parameters. Follow-up assessments will include ejaculatory function, erectile function, International Prostate Symptom Score, post-void residual urine, uroflowmetry, perioperative complications, and need for retreatment.

Inclusion criteria

• Male patients with lower urinary tract symptoms secondary to benign prostatic obstruction after failed medical treatment for at least 3 months.
• Sexually active patients with a continuous relationship with the same partner.
• International Prostate Symptom Score of 8 or greater.
• Transrectal ultrasound-estimated prostate size between 40 and 100 cc.
• Eligible for bipolar transurethral enucleation of the prostate.
• Ability to complete the required sexual and urinary function questionnaires.
• Ability to provide written informed consent.

Exclusion criteria

• Preoperative sexual dysfunction.
• Preoperative ejaculatory dysfunction.
• Diagnosis or suspicion of prostate cancer.
• Neurological disorders affecting lower urinary tract or sexual function.
• Detrusor hypocontractility.
• Catheter-dependent patients.
• Patients with bladder stones.
• Inability or refusal to provide informed consent.