Ejaculatory-sparing transurethral prostatectomy: a meta-analysis of randomized controlled trials

Abstract Introduction Benign prostatic hyperplasia (BPH) is a prevalent urologic condition leading to lower urinary tract symptoms (LUTS). Transurethral prostatectomy has been a cornerstone for surgical management of LUTS due to BPH. A growing interest has recently emerged to develop a surgical approach that can decrease the effect on sexual and ejaculatory functions while maintaining its efficacy in treating LUTS. Objective The aim of this meta-analysis is to assess patient-reported outcomes of ejaculatory-sparing transurethral prostatectomy in management of BPH. Methods Cochrane Library, Scopus, PubMed, and Web of Science databases were searched systematically until July 6, 2024. Randomized controlled trials reporting data on ejaculatory-sparing techniques during transurethral prostatectomy were included. The Cochrane risk-of-bias tool for randomized trials was used for quality assessment. The meta-analysis was conducted with Review Manager software. Numerical data were analyzed by standardized mean difference (SMD), while the risk ratio was used for analysis of categorical data. Fixed or random effects models were used according to heterogeneity. Results Five randomized controlled trials were included with 274 patients. No statistically significant differences were found between groups for International Prostate Symptom Score (SMD, 0.07; 95% CI, –0.45 to 0.59; P = .79), Qmax (SMD, –0.53; 95% CI, –1.11 to 0.06; P = .08), and International Index of Erectile Function (SMD, 0.89; 95% CI, –0.07 to 1.84; P = .07). Ejaculation was better preserved in ejaculatory-sparing techniques (risk ratio, 0.19; 95% CI, 0.12-0.30; P < .00001). Conclusions Ejaculatory-sparing transurethral prostatectomy techniques are feasible to preserve ejaculation while improving outcomes without compromising functional voiding outcomes.