Ejaculations and Benign Prostatic Hyperplasia: An Impossible Compromise? A Comprehensive Review

This review examined the relationship between benign prostatic hyperplasia (BPH) and ejaculatory disorders (EjD) in men over 50, finding that nearly 46% of men with lower urinary tract symptoms (LUTS) reported EjD. It analyzed 65 articles and found that medical treatments often led to anejaculation, while surgical treatments like trans-urethral resection of the prostate (TURP) were associated with high rates of retrograde ejaculation. Newer surgical techniques aimed to preserve antegrade ejaculation with promising results. The review emphasized the importance of evaluating EjD before treatment and preserving peri-montanal tissue during surgery to maintain antegrade ejaculation. It highlighted the need for practitioners to discuss potential sexual side effects with patients before starting treatment, especially with dual therapies that combine alpha-blockers and 5-alpha reductase inhibitors, which showed higher rates of ejaculatory dysfunction. Emerging therapies like Rezum©, Urolift©, and Aquablation© offered potential benefits for younger patients desiring to maintain ejaculatory function, though they had higher retreatment rates.