الفهرس 
ANATOMY OF THE PROSTATEOnly 14 pages are availabe for public view
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Abstract
T
he objective of our randomized study was to compare the outcomes of Ejaculation-Preserving Transurethral Resection of the Prostate (EP-TURP) and Conventional Transurethral Resection of the Prostate (C-TURP) methods. Specifically, we aimed to assess and compare the incidence and severity of complications associated with both techniques, with a focus on their impact on postoperative outcomes.
A total of 106 participants were enrolled in the study, with 53 cases assigned to each group. Participants were randomly assigned to either the control group or the observation group. Control group (C-TURP): Participants in this group underwent C-TURP. Observation group (EP-TURP): Participants in this group underwent EP-TURP following standardized surgical procedures aimed at preserving ejaculatory function.
The results of our present study can be summarized as follows:
• While both procedures resulted in comparable improvements across IPSS, Qmax, and PVRU with no significant differences between groups, antegrade ejaculation was maintained in 44/53 (83%) of ejaculation-sparing TURP patients compared to only 10/53 (19%) undergoing conventional TURP (p<0.001). The clear differences in rates of retrograde ejaculation highlight the advantage of the ejaculation-preserving approach in avoiding this problematic complication and resultant impairment in quality of life after prostate surgery.
• Our study demonstrated statistically significant postoperative improvements in IPSS symptom scores (reduced by 56.86% on average), peak urinary flow rates (increased by an average of 62.13%), and post-void residual urine volumes (decreased by a median of 52.05%). Additionally, 44 out of 53 (83%) patients maintained normal antegrade ejaculation after the ejaculation-sparing procedure.
• There was no statistically significant difference between control and observation group surgery time with p-value = 0.743
• 94.3% of patients in the ejaculation-sparing group maintained early urinary continence after surgery versus 79.2% in the conventional TURP group (p=0.022). Additionally, rates of urge incontinence were significantly lower for ejaculation-preserving patients (5.7%) relative to 20.8% in the control arm. Therefore, along with preserving antegrade ejaculation and reducing various urinary symptoms as demonstrated in previous analyses, the novel surgical approach also provided better preservation of urinary control and fewer problems with postoperative incontinence.
• Our study demonstrated a significantly improved complication profile for the ejaculation-preserving TURP group compared to the conventional TURP group. 64.2% of ejaculation-sparing patients had no significant complications postoperatively, compared to only 22.6% in the conventional TURP arm (p<0.001). Conversely, conventional TURP was associated with higher rates of dysuria (43.4% vs 5.7%, p<0.001), mild urgency (15.1% vs 1.9%, p=0.015), and increased urinary frequency (15.1% vs 0%, p=0.003). The ejaculation-preserving technique appears to reduce multiple problematic lower urinary tract symptoms commonly seen after standard TURP, in addition to preserving antegrade ejaculation.
• There was no statistically significant difference between control and observation group regarding intraoperative blood loss with p-value = 0.743
CONCLUSION
O
ur randomized study demonstrated that ejaculation-preserving transurethral resection of the prostate (EP-TURP) provides equivalent improvements in lower urinary tract symptoms compared to conventional TURP, while preserving antegrade ejaculation and reducing complications. 83% of EP-TURP patients maintained normal ejaculation post-operatively versus only 19% with conventional TURP (p<0.001). EP-TURP also resulted in significantly better urinary continence outcomes (94.3% vs 79.2%, p=0.022) and fewer bladder outlet symptoms like dysuria, urgency and frequency (p<0.05). Taken together, EP-TURP is an efficacious procedure for benign prostatic hyperplasia that maintains sexual function and reduces postoperative side effects. Our data supports EP-TURP as a preferential surgical modality over conventional TURP.
RECOMMENDATIONS
• EP-TURP should be considered the procedure of choice over conventional TURP for symptomatic BPH requiring surgery, given better preservation of antegrade ejaculation and reduced complications.
• Patient counseling and informed consent prior to TURP should include discussion of potential retrograde ejaculation risks and available ejaculation-sparing approaches.
• Training of urologic surgeons in EP-TURP technique should be expanded to make this approach more widely available.
• Further studies can help standardize EP-TURP procedural details to optimize maintenance of antegrade ejaculation rates.
• Quality of life and satisfaction measures should be included in future studies to complement objective outcomes when comparing TURP modalities.