Ejaculation preserving vs. standard transurethral resection of the prostate: a randomized controlled clinical trial

Transurethral resection of the prostate (TURP) is the gold standard treatment for moderate to severe lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH), offering significant symptom relief by enhancing urinary flow and lowering post-void residual (PVR) volume. This study aimed to compare the outcomes of ejaculation-preserving (EP) TURP versus standard TURP with respect to urinary function, erectile function, and ejaculatory preservation. This randomized controlled study included 90 men with drug-refractory LUTS secondary to BPH, including patients with urinary retention, who underwent TURP. Participants were placed into two equal groups: Group 1: were subjected to EP-TURP, and group 2: underwent standard TURP. Ejaculatory preservation at three and six months was significantly higher in Group 1 than Group 2 (81.4% vs. 19.51% and 79.07% vs. 19.51%, respectively; P < 0.001). IPSS showed no significant difference between groups at both follow-up points. PVR was significantly higher in Group 1 at three and six months (55 vs. 39 ml, P = 0.003; and 49 vs. 34 ml, P < 0.001). Qmax was lower in Group 1 at three months (19.04 ± 4.77 vs. 21.73 ± 4.63 ml/sec, P = 0.03) but comparable at six months. IIEF-5 scores were significantly better in Group 1 at both visits. Younger patients (< 60 years) had higher ejaculation preservation rates (P < 0.05) in EP-TURP cases. Intraoperative complications were lower with prostate volumes < 60 ml (P = 0.042). Operative time and sperm concentration were significantly reduced in Group 1. EP-TURP was an effective alternative to standard TURP, maintaining similar voiding outcomes while providing superior erectile function and ejaculatory preservation, particularly in younger men.