Impact of bladder neck preservation in transurethral resection of the prostate on postoperative retrograde ejaculation

Introduction. Prostatic enlargement with bladder outlet obstruction is one of the major problems that face many men after reaching 40 years old. There are different modalities for management of obstructed benign prostatic hyperplasia (BPH), while choose certain modality depends on many factors.

Aim. To evaluate the safety and efficiency of transurethral resection of the Prostate (TURP) with preservation of the bladder neck and compare it with the conventional standard TURP and its impact on retrograde of ejaculation.

Materials and methods. This prospective randomized comparative clinical study was conducted on 70 patients with obstructed benign prostatic hyperplasia attended to urology department outpatient clinic at Ain Shams university hospitals during the period from July 2021 to September 2023.

Results. Mean operative time was 57.14 min in group A and 56.66 min in group B. Reduction of hemoglobin postoperative was 1.24 g/dl in group A and 1.21 g/dl in group B. Mean hospital stay postoperatively was 2.71 days in group A and 2.77 days in group B. Catheter was removed after mean 2.96 days in group A and 3.11 days in group B. As regard postoperative incontinence, at the third month of follow up there were two patients in group A and eight patients in group B with statistically significant difference between the two groups.

Discussion. The study evaluated the safety and effectiveness of transurethral resection of the prostate (TURP) with bladder neck preservation compared to standard TURP. Bladder neck preservation significantly reduces retrograde ejaculation rates (14.3% vs. 74.1% after 12 months) while maintaining comparable efficacy and complication rates.

Conclusion. The TURP with preservation of the bladder neck is applicable technique for men with obstructed BPH with good efficacy and outcome comparable to conventional TURP. TURP with preservation of the bladder neck plays an important role in the armamentaria of ejaculation preservation post TURP.

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