<p><strong>In patients with LUTS/BPH pursuing ejaculation-sparing procedures, clinicians should discuss that the tissue preserving nature of these technologies increases the risk for BPH-specific retreatment. (<em>Expert Opinion)</em></strong></p>
Discussion
Discussion
<p>Non-ablative therapies (often termed “minimally invasive”) frequently have retrograde ejaculation rates that are in the single digit percentages and frequently approach zero. However, these procedures have also demonstrated higher BPH-specific retreatment rates especially in larger prostates likely related to the preservation or persistence of tissue.<sup>264, 265</sup> These ejaculatory-sparing procedures are frequently either non-ablative or lead to less robust tissue removal than debulking procedures.</p>
<p>Interestingly, the use of templated procedural options that target removal of specific portions of the prostate and spare the area around the verumontanum may allow for an optimization of urinary outcomes with a decrease in EjD. New techniques involving sparing of certain structures in transurethral ablative procedures (“ejaculation hood-sparing”) have decreased EjD rates for these procedures from the frequently quoted 70% to a rate closer to 20%.<sup>266, 267</sup> RWT which uses ultrasound-guided templating to target tissue removal may opt for sparing the prostate tissue around the verumontanum. Contemporary EjD rates for RWT are now 10% with the authors finding that penetration of the ejaculatory ducts and depth of penetration at the verumontanum predicted a higher likelihood of EjD.<sup>268, 269</sup></p>
<p>However, the long-term data for tissue-sparing during ablative procedures have not yet matured to assess durability. With potentially a few exceptions (depending on long-term outcomes), there exists a trade-off between the selection of an ejaculatory-sparing procedure in that there appears to be higher BPH-specific needs for retreatment in these patients.</p>