The Clinical Efficacy Of Sparing The Proximal Part Of Verumontanum For Reducing Retrograde Ejaculation In Patients Undergoing Holmium Laser Enucleation Of The Prostate

Objective:To investigate the clinical efficacy of sparing the proximal part of verumontanum for reducing retrograde ejaculation in BPH patients who undergoing Holmium laser enucleation of the pro state. Combined with literature to review the traditional physiological mechanism of ejaculation.Methods:40 patients who were diagnosised BPH actually were randomly divided into HoLEP group(n=20) and EP-HoLEP group(n=20). EP-HoLEP group received the ejaculation-preserving technique which preserving the tissue> 1 cm proximal to the verumontanum. The HoLEP group underwent conventional operation.The perioperative and postoperative indexes after Smonths^ 6 months-.12months were recorded and analyzed, erectile function and retrograde ejaculation were also observed.Results:There was no statistical significance of preoperative factors between the two groups(P>0.05). The operation was successfully completed and the weight of removed adenoma tissue were (35.7±16.6) g in HoLEP group and (32.9±12.9) g in EP-HoLEP group.there was no statistically significant difference(P> 0.05).Following-up 3 months,6 months and 12 months, the Qmax、PVR、IPSS、 and QOL were significantly improved than preoperation (P<0.01).but the differences between these two groups were not significant(P>0.05); Compared with preoperation, the erectile function had no statistical significance(P> 0.05).Before operation,the volume of semen were (3.1±0.6) ml in HoLEP group and (3.4±0.7) ml in EP-HoLEP group (P> 0.05); after 12 months, there were (1.2±1.3) ml and (2.3 +1.5)ml (P<0.05). Overall success rate of ejaculation preservation were 25% in HoLEP group and 60% in EP-HoLEP group, the rate of retrograde ejaculation were 75% in HoLEP group and 40% in EP-HoLEP group (P<0.05).Conclusions:With preserving the tissue> 1 cm proximal to the verumontanum in Holmium laser enucleation of the prostate, antegrade ejaculation was preserved and the rate of retrograde ejaculation was reduced. EP-HoLEP group and the traditional HoLEP group had the similar clinical curative effects in the improvement of urination. The results from this study underline the necessity of reviewing the traditional concept of ejaculation physiology.