- Design
- Systematic review and meta-analysis with trial sequential analysis
- Population
- 1493 men having BPH surgery across 16 studies (9 RCTs)
- Primary outcome
- Preservation of antegrade ejaculation
- Effect
- OR 6.76 (95% CI 3.86 to 11.84); IPSS MD 0.05 (−1.59 to 1.68)
A meta-analysis of 16 studies — 9 randomised, 7 observational — covering 1493 men compared ejaculation-sparing with standard techniques for benign prostatic obstruction.
Ejaculation-sparing techniques preserved antegrade ejaculation far more often (OR 6.76, 95% CI 3.86 to 11.84). Techniques preserving the bladder neck and supramontanal tissue showed the largest effect (OR 17.79). At 6–12 months, IPSS (mean difference 0.05), flow rate and erectile function did not differ.
The symptom relief was preserved while a key side effect was largely avoided. Follow-up is short, and techniques were not standardised, so durability of the urinary benefit is not yet known.
- Offer an ejaculation-sparing technique to men who want to preserve ejaculation.
- Explain that durability beyond a year is less certain.
- Choose a technique your unit performs consistently.
- Audit re-treatment rates if you adopt it.
Why it matters
It removes much of the trade-off men have been asked to accept for relief of obstruction.
Don't overread it
Short follow-up; whether ejaculation-sparing techniques need more re-operations later is unknown.
The statistics, in plain English
An odds ratio of 6.76 is a very large effect. The subgroup estimates vary widely, and mixing randomised and observational studies adds uncertainty; the IPSS difference of 0.05 points is effectively zero.
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