Ejaculation-preserving holmium laser enucleation of the prostate: a systematic review of techniques, functional outcomes, and safety
-
By
-
March 21, 2026
Objective:
To systematically review ejaculation-preserving modifications of HoLEP and compare preservation of antegrade ejaculation (AE) between EP-HoLEP and standard techniques, while evaluating urinary function, continence, peri-operative safety, and reintervention needs, specifically focusing on the differences in outcomes.
Key Findings:
- Conventional HoLEP is associated with high rates of retrograde ejaculation (RE), impacting sexual function, which necessitates the exploration of alternative techniques.
- Anatomical studies suggest that preserving peri-verumontanum and bladder-neck structures is crucial for maintaining AE, highlighting the need for surgical adaptations.
- Various ejaculation-preserving techniques have been proposed, but evidence on their effectiveness remains fragmented, indicating a gap in clinical guidelines.
Interpretation:
The review highlights the need for standardized definitions and reporting in studies of ejaculation-preserving HoLEP techniques to better assess their impact on sexual and urinary outcomes, including specific metrics for evaluation.
Limitations:
- Heterogeneity in study designs, patient selection, and outcome definitions complicates direct comparisons, which may lead to inconsistent clinical applications.
- Limited high-quality evidence on the effectiveness of various ejaculation-preserving techniques restricts the ability to draw definitive conclusions for clinical practice.
Conclusion:
A systematic review of EP-HoLEP techniques is necessary to synthesize current knowledge and guide future research on preserving ejaculatory function in BPH surgery, emphasizing the need for robust evidence to inform clinical decisions.
