Evaluating outcomes of combined bladder neck and supramontanal sparing ejaculatory preserving transurethral resection of the prostate: Results from a prospective, randomised study

INTRODUCTION: Although conventional transurethral resection of the prostate (TURP) is highly successful in improving urinary symptoms and flow rates, a higher incidence of loss of antegrade ejaculation has been reported. Therefore, we aimed at prospectively comparing the efficacy and outcomes of a novel dual bladder neck and supramontanal sparing TURP to conventional TURP to improve voiding and ejaculation. MATERIAL AND METHODS: Between January 2019 and November 2020, all patients with benign prostatic hyperplasia (BPH) satisfying the eligibility criteria underwent either conventional TURP (Group 1) or combined bladder neck and supramontanal sparing TURP (Group 2) after randomisation. The groups were compared for functional outcomes including International Prostate Symptom Score (IPSS), peak flow rates, post-void residual urine, perioperative variables and postoperative complications. Ejaculation was assessed with International Index of Erectile Function-Question 9 (IIEF-9) and Ejaculation Projection score (EPS). RESULTS: A total of 90 patients were randomised, 45 each to Group 1 and 2 respectively. The demographic profiles across both groups were comparable. Retrograde ejaculation and bladder neck contracture were significantly higher in Group 1. Both groups demonstrated significant improvement in the IPSS (26.12 ±2.88 to 4.69 ±0.87 (Group 1) vs 26.60 ±3.45 to 4.36 ±1.74 in Group 2) and Qmax (7.03 ±2.71 to 24.36 ±3.82 mL/s in Group 1 vs 6.29 ±2.64 to 25.28 ±4.33 mL/s in Group 2) at 3 months. However, a significant difference in IPSS and Qmax were recorded at 6 months. IIEF-9 score in Group 2 remained similar to preoperative profile (4.18 ±0.75) vs 2.58 ±0.86 (Group 1). EPS significantly decreased in Group 1 but remained similar to preoperative EPS in Group 2. Antegrade ejaculation was preserved in 88.89% in Group 2 as compared to 22.22% in Group 1. CONCLUSIONS: Dual bladder neck and supramontanal ejaculation preserving TURP is superior to conventional TURP in preventing retrograde ejaculation and bladder neck contractures in prostates <50 cc with comparable functional results, perioperative and postoperative morbidity.