Objective: to compare between bipolar resection and bipolar enucleation regarding preserving antegrade ejaculation using a new innovative technique of ejaculation preserving bipolar prostatectomy.
Patients and method: 100 consecutive patients with BPH and normal sexual activity enrolled from June 2015 to June 2016, were selectively randomized into two groups each group included 50 patients, group (1) underwent ejaculation preserving transurethral bipolar enucleation of prostate while group (2) underwent ejaculation preserving trans urethral bipolar resection of prostate, all patients were prospectively evaluated with objective and subjective endpoints of change in (Qmax ,PVRU, IPSS and IIEF-5 with two additional questions evaluating ejaculation and orgasm), all patients were followed up at 1 , 3 , 6 months
Results: Overall, 100, 98 and 97 patients were evaluated at 1, 3 and 6 months, respectively. Antegrade ejaculation was preserved in 88 of 100 (88%) “45 patients in group (1) and 43 patients in group (2) " at 1 month follow up. Significant improvements in maximum flow rate from 6.54±1.72ml/sec preoperatively to 15.38±3.02 ml/sec, and PVR from 94.4±41.85 ml preoperatively to 25.04±32.72 ml was observed at 1 month follow up. Micturition symptoms, as measured by IPSS were also significantly reduced from 21.7±6.6 preoperatively to 11.72±2.39 at 1 month follow up. Improvements were maintained at 3 and 6 months follow up. No serious adverse events were reported. Only one patient developed retention after catheter removal and he needed 2nd look cystoscopy during which residual adenoma detected and vaporized
Conclusion: with clear understanding of the new theory of ejaculation ante grade ejaculation can be preserved using the innovative technique of ejaculation preserving trans urethral bipolar prostatectomy either with adoption of the enucleation or resection technique. Our functional and symptomatic results were comparable to ep –TURP and better than ep –HOLEP