Outcomes and Efficacy of Ejaculatory Preserving Transurethral Resection of Prostate
Phase: NA
Conditions: Ejaculatory Dysfunction, BPH
Sponsor: Sohag University

Patients and Methods
 
 
Outcomes and Efficacy of Ejaculatory Preserving 
Transurethral Resection of Prostate 
NCT05914519 
Date 15/10/2025 
 
Introduction: 
The prostatic gland plays a central role in andrology. It is involved both in 
fertility and in sexuality with a major role in ejaculation and possibly in 
orgasm. This could explain the association between the andrological 
symptoms and prostatic disorders [1]. 
The prevalence of Benign Prostatic Hyperplasia (BPH) is approximately 
50% for men in their fifties and reaches up to 80% for men over 80 years 
of age, representing one of the most common diseases affecting males, with 
potentially significant impact on their quality of life [2]. 
It is estimated that around half of men suffering severe or medical 
treatment unresponsive lower urinary tract symptoms (LUTS) will be 
offered a surgical procedure to relieve benign prostatic obstruction (BPO) 
[3]. 
Despite continuing development of new minimally invasive surgical 
methods, transurethral resection of the prostate (TURP) still remains the 
gold standard surgical treatment for LUTS due to BPH [4, 5] 
Although it is benign, this disease has been shown to have a negative 
impact on the patient’s health-related quality of life (HRQL), marked by 
obstructive and irritative LUTS [6, 7]. 
As BPH in most cases is not a life-threatening condition, the main 
outcomes of its treatment are not only the improvement in LUTS and 
functional parameters but also quality of life after surgery [8]. 

Patients and Methods
 
 
Whilst efficacy of the conventional TURP is proven, a common potentially 
bothersome side effect, the retrograde ejaculation (RE) which occurs in 
65–90% of patients undergoing TURP [9]. 
It has been reported that ablative techniques like TURP and recent laser 
procedures including holmium, thulium and greenlight cause similar rates 
of ejaculatory dysfunction, occurring in almost three out of four to five men 
[10]. 
For decades, men have been counseled to expect dry orgasm after TURP 
because of the retrograde flow of semen as a result of bladder neck 
disruption [11]. 
Erectile dysfunction and Ejaculatory dysfunction (EjD) can have a 
substantial deleterious effect on the Quality of life (QoL) of men who have 
previously maintained regular sexual activity, inducing significantly 
increased levels of anxiety and depression [12]. 
More recently, a better understanding of ejaculation physiology has 
enabled the emergence of modified surgical techniques with the aim of 
preserving antegrade ejaculation [13–16]. 
The key point of standard TURP is resecting the tissues enveloped in the 
prostatic capsule and the bladder neck, while protecting the urethral tissues 
below the verumontanum [17]. 
The bladder neck plays a significant role in reproduction. For men, bladder 
neck closure facilitates anterograde ejaculation. It actively contracts the 
bladder neck during ejaculation through a rich noradrenergic innervation 
by sympathetic nerves [18]. 
Vernet et al. showed that contraction of the bladder neck was not important 
for anterograde ejaculation [19]. Using endorectal ultrasound videos 
performed during masturbation in 30 men, it was possible to visualize the 
bladder neck, the prostate, and the bulbar urethra during ejaculation. They 
observed that during ejaculation, the verumontanum underwent a slight 

Patients and Methods
 
 
caudal shift, momentarily making contact with the opposite urethral wall 
and sperm emitted from the ejaculatory ducts was directed distally by 
contractions of the external sphincter coordinated with contractions of the 
bulbar urethra, thus demonstrating the importance of the muscular tissue 
around the verumontanum and particularly its proximal part. They 
described this area as a “high-pressure ejaculatory area”. The closure of the 
bladder neck did not seem to play a role in this mechanism. As a result, one 
can conclude that as long as the tissues around the verumontanum are not 
injured, ejaculation should still occur even with a well-open bladder neck 
[20]. 
Recently, together with a better understanding of the mechanisms of 
ejaculation, a greater importance has been given to the impact of dry 
ejaculation on patients’ QoL [21]. A balance between symptomatic 
improvement in LUTS and preservation of sexual function needs to be 
addressed for men seeking surgical treatment [22]. 
Modifications based on Supramontanal sparing hypothesis have reported 
favorable outcomes to as high as 92% [23]. 
Although preservation of bladder neck structures is often associated with 
preservation of antegrade ejaculation, the current modern approach is the 
preservation of the precollicular and para-collicular tissue in the area where 
the ejaculatory ducts emerge near the verumontanum in the distal apical 
tissue in laser, aquablation, and bipolar electrosurgical prostatectomy 
techniques [24]. 
Aim of the work:  
The purpose of this study is to assess the outcomes and efficacy of 
ejaculatory preserving TURP in terms of voiding, erectile function, and 
ejaculation. 
Patients and method: 

Patients and Methods
 
 
-Place of the study: 
Sohag university hospital, Urology department. 
-Type of the study: 
A prospective comparative study. 
-Study Population: 
The study will be carried out between July 2023 and January 2025. All 
patients who are eligible for inclusion will be picked up from Sohag 
University Hospital's urology outpatient clinic and will undergo TURP. 
They will be assigned to two groups. 
-Patients: 
-Inclusion criteria: 
Adult patient < 45 years old.  
Men with drug refractory urinary retention. 
Prostate volume range: 20–60 mL. 
The International Prostate Symptom Score (IPSS) > 19 after the medical 
therapy failure.  
Maximum urinary flow rate (Qmax) < 10 mL/s. 
Serum prostate-specific antigen (PSA) < 4 ng/mL with biopsy proven BPH 
if serum PSA >4 ng/mL or abnormal digital rectal examination findings.  
Active and healthy sexual life with an ability to ejaculate (reported sexual 
activity over the last 3 months). 
 
 
 
 
-Exclusion criteria: 

Patients and Methods
 
 
History of prostate, bladder or urethral surgery.  
Neurogenic bladder.  
Untreated active urinary tract infection (UTI).  
Urethral stricture disease.  
Biopsy confirmed prostate cancer. 
Bleeding diathesis. 
Capsular or bladder perforation during surgery. 
-Ethical consideration: 
All patients will be fully informed about the operations, and written 
informed consents will be obtained. 
Approval from ethical committee of Sohag faculty of medicine will be 
obtained. 
-Methods of the study: 
Pre-operative Evaluation: 
- History, which includes IPSS, the International Index of Erectile Function 
5 items Questionnaire (IIEF-5Q), and the Male Sexual Health 
Questionnaire-Ejaculatory Dysfunction Short Form (MSHQ-EjD).  
- Physical examination, which includes a digital rectal examination.  
- A pre-operative lab study, which includes urine analysis, hemoglobin, 
creatinine, and PSA levels.  
-Trans abdominal ultrasonography to determine prostate volume and post 
void residual (PVR) urine volume.  
- Uro-flow-metry (Qmax). 
Surgical Technique: 
Cystoscopy will be conducted under spinal anaesthesia with a 30° 
telescope and the patient in dorsal lithotomy posture. Eligible patients will 
be randomly assigned to one of two groups with double blind evaluation. 
Group 1 will have ejaculatory preserving TURP, whereas Group 2 will 

Patients and Methods
 
 
have traditional TURP. Randomization will be done by computer 
programming such as SAS. The Operators will be the supervisors of the 
principle investigator. 
All procedures will be carried out with bipolar-flow 26 Fr bipolar 
resectoscopes (Karl-Storz, Germany) configured for resection in 0.9% 
saline solution and cut/coagulation set at 130/70 W. 
In Group 1, resection of lateral lobes to the capsule and the ventral side to 
the level of the verumontanum with avoidance of paracollicular digging. 
Circular resection of the internal bladder neck will be done. Then the next 
step will be apical resection utilizing the colliculus seminalis as a distal 
resection border and maintaining a 1 cm safety area for preservation of 
ejaculation.  
In Group 2, the whole adenoma tissue, including the tissue in front of the 
verumontanum and bladder neck, will be removed to the prostatic capsule.  
After full hemostasis, a 20 Fr three-way catheter will be placed into the 
bladder, traction will be performed, and the bladder will be irrigated with 
0.9% saline postoperatively until clear effluent is seen. 
The patient will be discharged from the hospital on the next postoperative 
day. Sexual activity will be prohibited for 6 weeks following the 
intervention. 
Intra-operative Evaluation: 
The following intraoperative factors will be evaluated: operative time 
(calculated from the insertion of the resectoscope to the final removal of 
all resected prostatic tissues), blood transfusion requirement, and 
intraoperative complications such as bleeding, capsular perforation, and 
transurethral resection (TUR) syndrome. 
Post-operative Evaluation: 
Clot retention, hemoglobin reduction, and electrolyte imbalance will be 
detected and treated postoperatively. 
Follow up: 

Patients and Methods
 
 
All patients will be followed-up regularly at 3 and 6 months 
postoperatively with the IPSS, Qmax, PVR, IIEF-5Q, MSHQ-EjD Short 
Form, and rates of complications (including urethral stricture, 
incontinence, bladder neck contracture, Recatheterisation, UTI, and 
retrograde ejaculation). 
 
 
 
 
List of abbreviations: 
 
BPH 
Benign Prostatic Hyperplasia 
LUTS 
Lower urinary tract symptoms 
BPO 
Benign prostatic obstruction 
TURP 
Transurethral resection of the prostate 
HRQL 
health-related quality of life 
RE 
retrograde ejaculation (RE) 
EjD 
Ejaculatory dysfunction 
QoL 
Quality of life 
IPSS 
International Prostate Symptom Score 
Qmax 
Maximum urinary flow rate 
PSA 
prostate-specific antigen 
UTI 
urinary tract infection 
IIEF-5Q 
International Index of Erectile Function 5 items 
Questionnaire 
MSHQ-EjD 
Male 
Sexual 
Health 
Questionnaire-Ejaculatory 
Dysfunction 
PVR 
postvoid residual 
TUR 
Transurethral resection 
 
 

Patients and Methods
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
References: 
1. Wein, A.J.; Coyne, K.S.; Tubaro, A.; Sexton, C.C.; Kopp, Z.S.; Aiyer, 
L.P. The impact of lower urinary tract symptoms on male sexual health: 
EpiLUTS. BJU Int. 2009, 103 (Suppl. 3), 33–41. 
2. Vuichoud C, Loughlin KR. Benign prostatic hyperplasia: Epidemiology, 
economics and evaluation. Can J Urol. 2015;22(Suppl 1):1–6. 
3. Drake M, Lewis AL, Younbg GJ et al (2020) Diagnostic assessment of 
lower urinary tract symptoms in men considering prostate surgery: a 
noninferiority randomized controlled trial or urodynamics in 26 hospitals. 
Eur Urol 78:701–710.  
4. Peng M, Yi L, Wang Y. Photoselective vaporization of the prostate vs 
plasmakinetic resection of the prostate: a randomized prospective trial with 
12-month follow-up in mainland China. Urology 2016; 87: 161-5.  
5. Zhang X, Zeng X, Dong L, et al. The effects of statins on benign 
prostatic hyperplasia in elderly patients with metabolic syndrome. World J 
Urol 2015; 33: 2071-7. 

Patients and Methods
 
 
6. Zhu BS, Jiang HC, Li Y. Impact of urethral catheterization on uroflow 
during pressure-flow study. J Int Med Res 2016; 44: 1034-9.  
7. Unnikrishnan R, Almassi N, Fareed K. Benign prostatic hyperplasia: 
evaluation and medical management in primary care. Cleve Clin J Med 
2017; 84: 53-64. 
8. Becher EF, McVary KT. Surgical procedures for BPH/LUTS: Impact on 
male sexual health. Sex Med Rev. 2014;2(1):47–55. 
9. Liao J, Zhang X, Chen M, et al. Transurethral resection of the prostate 
with preservation of the bladder neck decreases postoperative retrograde 
ejaculation. Wideochir Inne Tech Maloinwazyjne. 2019; 14: 96-101. 
10. Rieken M, Antunes-Lopes T, Geavlete B, Marcelissen T; EAU Young 
Academic Urologists Functional Urology and BPH Group. What Is New 
with Sexual Side Effects After Transurethral Male Lower Urinary Tract 
Symptom Surgery? Eur Urol Focus 2018;4:43–5. 
11. Muntener M, Aellig S, Kuettel R, Gehrlach C, Sulser T, Strebel RT. 
Sexual function after transurethral resection of the prostate (TURP): results 
of an independent prospective multicentre assessment of outcome. Eur 
Urol. 2007;52(2):510–5. 
12. Feldman HA, Goldstein I, Hatzichristou DG et al. Impotence and its 
medical and psychosocial correlates: results of the Massachusetts Male 
Aging Study. J Urol.1994;151:54–61. 
13. Ronzoni G, De Vecchis M. Preservation of anterograde ejaculation 
after transurethral resection of both the prostate and bladder neck. Br J 
Urol. 1998;81:830–833.  
14. Alloussi SH, Lang C, Eichel R, Alloussi S. Ejaculation-preserving 
transurethral resection of prostate and bladder neck: shortand long-term 
results of a new innovative resection technique. J Endourol Endourol Soc. 
2014;28:84–89. https://doi.org/10.1089/ end.2013.0093. 
15. Talab SS, Santiago-Lastra YA, Bachmann A et al. V403 the impact of 
ejaculation-preserving photo-selective vaporization of the prostate (EP-
PVP) on lower urinary tract symptoms and ejaculatory function: results of 
a 
multicenter 
study. 
J 
Urol.2013;189:e164. 
https://doi.org/10.1016/j.juro.2013.02.1792. 

Patients and Methods
 
 
16. Kim M, Song SH, Ku JH et al. Pilot study of the clinical efficacy of 
ejaculatory hood sparing technique for ejaculation preservation in holmium 
laser enucleation of the prostate. Int J Impot Res. 2015;27:20–24. 
https://doi.org/10.1038/ijir.2014.22. 
17. Thomas AW, Cannon A, Bartlett E, et al. The natural history of lower 
urinary tract dysfunction in men: minimum 10-year urodynamic follow up 
of transurethral resection of prostate for bladder outlet obstruction. J Urol 
2005; 174: 1887-91. 
18. He LY, Zhang YC, He JL, et al. The effect of immediate surgical 
bipolar plasmakinetic transurethral resection of the prostate on prostatic 
hyperplasia with acute urinary retention. Asian J Androl 2016; 18: 134-9. 
19. Gil-Vernet JM, Alvarez-Vijande R, Gil-Vernet A, Gil-Vernet JM. 
Ejaculation in men: a dynamic endorectal ultrasonographical study. Br J 
Urol. 1994;73:442–448.  
20. Sturch P, Woo HH, McNicholas T, Muir G. Ejaculatory dysfunction 
after treatment for lower urinary tract symptoms: retrograde ejaculation or 
retrograde thinking? BJU Int. 2015;115:186– 187. 
21. McMahon CG, Abdo C, Incrocci L, Perelman M, Rowland D, 
Waldinger M, et al. Disorders of orgasm and ejaculation in men. J Sex 
Med. 2004;1(1):58–65.  
22. Sturch P, Woo HH, McNicholas T, Muir G. Ejaculatory dysfunction 
after treatment for lower urinary tract symptoms: retrograde ejaculation or 
retrograde thinking? BJU Int. 2015;115(2):186–7. 
23. Alloussi SH, Lang C, Eichel R, Alloussi S. Ejaculation-preserving 
transurethral resection of prostate and bladder neck: short- and long-term 
results of a new innovative resection technique. J Endourol. 2014; 28: 84-
89. 
24. Kim M, Song SH, Ku JH, et al.: Pilot study of the clinical efficacy of 
ejaculatory hood sparing technique for ejaculation preservation in 
Holmium laser enucleation of the prostate. Int J Impot Res. 2015; 27(1): 
20–4.  
 

Patients and Methods
 
 
Statistical analysis: 
Statistical analysis was done by SPSS v26 (IBM Inc., Chicago, IL, 
USA). Shapiro-Wilks test and histograms were used to evaluate the 
normality of the distribution of data. Quantitative parametric variables were 
presented as mean and standard deviation (SD) and compared between the 
two groups utilizing unpaired Student's T- test. Quantitative non-parametric 
data were presented as median and interquartile range (IQR) and were 
analyzed by Mann-Whitney test. Qualitative variables were presented as 
frequency and percentage and were analyzed utilizing the Chi-square test 
or Fisher's exact test when appropriate. A two tailed P value < 0.05 was 
considered statistically significant

 
12 
Results 
In this study, 103 patients were assessed for eligibility; 8 patients did 
not meet the criteria and 5 patients refused to participate in the study. The 
remaining patients were randomly allocated into two equal groups (45 patients 
in each). All allocated patients were followed-up and analyzed statistically 
(Figure 42). 
 
Figure 1: CONSORT flow chart of the enrolled patients. 
 
 

 
13 
Table 1: Demographic data and comorbidities of the studied groups 
 
Group 1 
(n=45)
 
Group 2 
(n=45)
 
P value
 
Mean difference 
or RR (95% CI)
 
Age (years)
Mean ± SD
 
62.76 ± 8.16
 
65.58 ± 7.98
 
0.101
 
-2.82(-6.2: 0.56)
 
Range
 
46 - 85
 
50 – 83
 
Diabetes mellitus
 
9 (20%)
 
7 (15.56%)
 
0.581
 
1.29(0.52:3.15)
 
Hypertension
 
10 (22.22%)
 
10 (22.22%)
 
1
 
1(0.46:2.17)
 
Ischemic heart disease
 
2 (4.44%)
 
0 (0%)
 
0.153
 
---
 
CI: Confidence interval, RR: Relative risk  
Age, diabetes mellitus, hypertension and ischemic heart disease were 
insignificantly different between two groups.  
 
Figure 2: Age of the studied groups. 
 

 
14 
 
Figure 3: Comorbidities of the studied groups. 
  

 
15 
Table 2: IPSS score of the studied groups 
 
Group 1
 
(n=43)
 
Group 2
 
(n=41)
 
P value
Mean difference 
(95% CI)
 
Preoperative (0-35)
 
26.58±3.65
28.42±3.2
 
0.013*
 
-1.84(-3.28: -0.406)
 
3 months 
postoperative 
 
7.14±2.99
 
6.68±2.43
 
0.446
 
0.456(-0.729: 1.642)
6 months 
postoperative
 
5.12±2.62
 
4.07±3.38
 
0.117
 
1.043(-0.265:2.352)
 
*Significantly different as P value ≤0.05, CI: Confidence interval, IPSS: International prostate symptom 
Score 
IPSS score was significantly lower at preoperative (0-35) in group 1 
than group 2 as (P value = 0.013) and was insignificantly different at (3 and 6 
months) postoperative between both groups.  
 
Figure 4: IPSS score of the studied groups. 
 
 

 
16 
Table 3: IIEF-5Q score of the studied groups 
 
Group 1
 
(n=43)
 
Group 2
 
(n=41)
 
P value
 
Mean difference 
(95% CI)
 
Preoperative (5-25)
 
19.76±2.64
 
20.04±2.45
 
0.592
 
-0.289(-1.354: 0.776)
 
3 months postoperative 
 
20.14±2.58
 
18.41±2.49
 
0.003*
 
1.725(0.624:2.826)
 
6 months postoperative
 
20.05±3.11
 
17.78±2.96
 
<0.001*
 
2.266(0.947: 3.585)
 
*Significantly different as P value ≤0.05, CI: Confidence interval, IIEF-5Q: International index of erectile 
function – 5‑question version 
IIEF-5Q score was insignificantly different at preoperative (5-25) 
between both groups and was significantly higher at 3 and 6 months 
postoperative in group 1 than in group 2 (P value <0.05).  
 
Figure 5: IIEF-5Q of the studied groups. 

 
17 
Table 4: MSHQ-EjD score of the studied groups 
 
Group 1
 
(n=43)
 
Group 2
 
(n=41)
 
P value
 
Mean difference 
(95% CI)
 
Preoperative (1-15)
 
12.42±1.23
 
10.98±2.16
 
<0.001*
1.44(0.708: 2.181)
 
3 months postoperative
 
10.26±1.42
 
9.63±1.77
 
0.284
 
0.632(-0.544: 1.808)
 
6 months postoperative
 
10.62±1.76
 
10.38±2.26
 
0.741
 
0.243(-1.232: 1.717)
 
*Significantly different as P value ≤0.05, CI: Confidence interval, MSHQ-EjD: Male sexual health 
questionnaire – ejaculatory dysfunction short form, TTT: Treatment 
MSHQ-EjD score was significantly higher at preoperative (1-15) in 
group 1 than group 2 (P value <0.001) and was insignificantly different at three 
and six months postoperative between both groups. 
 
Figure 6: MSHQ-EjD of the studied groups. 
 

 
18 
Table 5: Laboratory investigation of the studied groups 
 
Group 1 
(n=45)
 
Group 2 
(n=45)
 
P value
 
Mean difference 
(95% CI)
 
Hemoglobin 
(g/dL)
 
Preoperative
 
13.34±1.85
 
13.88±1.35
 
0.121
 
-0.535(-1.21: 0.145)
Postoperative
 
12.29±1.73
 
12.55±1.58
 
0.466
 
-0.256(-949: 0.438)
 
/L)
9
WBC (10
Preoperative
 
8.23±3.27
 
8.1±2.88
 
0.842
 
0.13(-1.161: 1.42)
 
Postoperative
 
10.18±2.09
 
10.55±3.22
 
0.524
 
-0.366(-1.50:0.772)
 
Creatinine 
(mg/dL)
 
Preoperative
 
1.18±0.41
 
1.07±0.36
 
0.195
 
0.106(-0.055: 0.267)
Postoperative
 
1.11±0.24
 
1.1±0.33
 
0.874
 
0.009(-0.112: 0.132)
Total PSA 
(ng/mL)
 
Median
 
2.13
 
4.2
 
0.001*
 
1.41(0.60: 2.30)
 
IQR
 
1.39 - 3.8
 
2.6 - 5.3
 
*Significantly different as P value ≤0.05, WBC: White blood cell, CI: Confidence interval, PSA: Prostate-
specific antigen   
Hemoglobin, WBC and creatinine were insignificantly different at 
preoperative and postoperative between both groups. 
 Total PSA was significantly lower in group 1 than group 2 as (P value 
=0.001). 
 
Figure 7: Hemoglobin of the studied groups. 

 
19 
 
Figure 8: WBC of the studied groups. 
 
Figure 9: Creatinine of the studied groups. 

 
20 
 
Figure 10: Total PSA of the studied groups. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
21 
Table 6: Prostate volume (ml) of the studied groups 
 
Group 1 
(n=45)
 
Group 2 
(n=45)
 
P value
 
Mean difference 
(95% CI)
 
Prostate 
volume (ml)
 
Mean ± SD
 
53.69 ± 17.71
 
57.11 ± 19.16
 
0.381
 
-3.42(-11.15: 
4.31)
 
Range
 
25 – 89
 
24 – 106
 
*Significantly different as P value ≤0.05, PVR: Postvoid residual, Qmax: Maximum urinary flow rate, CI: 
Confidence interval 
Prostate volume was insignificantly different between both groups. 
 
 
Figure 11: Prostate volume of the studied groups. 
 
 
 
 
 

 
22 
Table 7: PVR (ml) and Qmax (ml/sec) of the studied groups 
 
Group 1 
(n=43)
 
Group 2 
(n=41)
 
P value
 
Mean difference 
(95% CI)
 
PVR (mL)
 
Preoperative
 
356 (250-380)
340 (289-391)
0.345
 
14(-20:48)
 
3 months 
postoperative
 
55 (43.5-68.5)
39 (29-52)
 
0.003*
 
-13(-22: -4)
 
6 months 
postoperative
 
49 (42.5-72)
 
34(22-47)
 
<0.001*
 
-21(-29: -12)
 
Qmax 
(mL/sec)
 
Preoperative
 
4.92±1.73
 
4.5±1.88
 
0.270
 
0.42(-0.334: 
1.178)
 
3 months 
postoperative
 
19.04±4.77
 
21.73±4.63
 
0.01*
 
-2.696(-4.738: -
0.654)
 
6 months 
postoperative
 
18.78±5.16
 
19.71±6.22
 
0.457
 
-0.93(-3.407: 
1.55)
 
*Significantly different as P value ≤0.05, PVR: Postvoid residual, Qmax: Maximum urinary flow rate, CI: 
Confidence interval 
PVR was insignificantly different at preoperative between both groups 
and was significantly higher at (3 months and 6 months) postoperative in group 
1 than group 2 as (P value =0.003 and <0.001 respectively). 
Qmax was significantly lower at 3 months postoperative in group 1 than 
group 2 as (P value =0.03) and was insignificantly different at (preoperative 
and 6 months postoperative) between both groups.  
 

 
23 
 
Figure 12: PVR of the studied groups. 
 
Figure 13: Qmax of the studied groups. 

 
24 
Table 8: Intraoperative factors of the studied groups 
 
Group 1 
(n=45)
 
Group 2 
(n=45)
 
P value
 
Mean 
difference or 
RR (95% CI)
 
Operative 
time (min)
 
Mean ± SD
 
33.51 ± 11.49
 
40.53 ± 14.64
 
0.013*
 
-3.42(-11.15: 
4.31)
 
Range
 
15 – 60
 
18 – 75
 
Blood transfusion
 
1 (2.22%)
 
2 (4.44%)
 
1
 
0.49(0.04:5.59)
 
*Significantly different as P value ≤0.05, CI: Confidence interval, RR: Relative risk 
Operative time was significantly lower in group 1 than group 2 as (P 
value =0.013). 
Blood transfusion was insignificantly different between both groups. 
 
Figure 14: Operative time of the studied groups. 
 

 
25 
 
Figure 15: Blood transfusion of the studied groups. 
  

 
26 
Table 9: Complications of the studied groups 
 
Group 1 
(n=45)
 
Group 2 
(n=45)
 
P value
 
Intraoperative
 
Capsular perforation
 
1 (2.22%)
 
2 (4.44%)
 
0.620
 
Intraperitoneal bladder 
perforation
 
0 (0%)
 
1 (2.22%)
 
Blood transfusion
 
1 (2.22%)
 
2 (4.44%)
 
Early 
postoperative
 
Severe irritative LUTs
 
4 (8.89%)
 
7 (15.56%)
 
0.506
 
Clot retention
 
2 (4.44%)
 
4 (8.89%)
 
Stress incontinence
 
1 (2.22%)
 
2 (4.44%)
 
Bladder neck contracture
1 (2.22%)
 
2 (4.44%)
 
 
Group 1 
(n=43)
 
Group 2 
 
(n=41)
 
P value
 
Late 
postoperative
 
Stricture bulbar urethra
 
1 (2.33%)
 
2 (4.88%)
 
0.699
 
Bladder neck contracture
1 (2.33%)
 
2 (4.88%)
 
LUTs: Lower urinary tract symptoms 
Complications (intraoperative, early and late postoperative) were 
insignificantly different between both groups. 
 
Figure 16: Complications of the studied groups. 
 

 
27 
Table 10: Post-operative preserved ejaculation, semen volume and 
concentration of the studied groups 
 
Group 1 (n=43)
Group 2 
(n=41)
 
P value
 
Median, mean 
difference or 
RR (95% CI)
 
Preserved 
ejaculation
 
After 3 months
 
35 (81.4%)
 
8 (19.51%)
 
<0.001*
 
18.05(6.07:53.6
4)
 
After 6 months
 
34 (79.07%)
 
8 (19.51%)
 
<0.001*
 
15.58(5.37:45.2
5)
 
Semen volume 
(mL)
 
After 3 months
 
2.37±0.78
 
2.01±0.58
 
0.223
 
0.362(-229: 
0.953)
 
After 6 months
 
2.41±0.78
 
2.49±0.73
 
0.797
 
-0.079(-0.165: 
0.535)
 
Sperm 
concentration 
(million 
sperm/mL)
 
After 3 months
 
35 (13.75-82)
 
72 (62.75-
89.25)
 
0.036*
 
37(8: 60)
 
After 6 months
 
32.5 (13-72)
 
86. (76-
106.75)
 
0.005*
 
54(20: 78)
 
*Significantly different as P value ≤0.05, CI: Confidence interval, RR: Relative risk  
Preserved ejaculation (after three and six months) were significantly 
higher in group 1 than group 2 (P value <0.001). 
Semen volume (after three and six months) was insignificantly different 
between both groups. 
Sperm concentration (after three and six months) was significantly 
lower in group 1 than group 2 (P value<0.05). 

 
28 
 
Figure 17: Preserved ejaculation of the studied groups.
 
Figure 18: Semen volume of the studied groups. 

 
29 
 
Figure 19: Sperm concentration of the studied groups. 
 
  

 
30 
Table 11: Relation between age groups and preservation of ejaculation   
 
<60 years 
(n=24)
 
(60-70) years 
(n=46)
 
>70 years 
(n=14)
 
P value
 
After 3 months
 
17 (70.83%)
 
24 (52.17%)
 
2 (14.29%)
 
0.003*
 
After 6 months
 
17 (70.83%)
 
23 (50%)
 
2 (14.29%)
 
0.004*
 
*Significantly different as P value ≤0.05  
Preserved ejaculation after three and six months were significantly 
higher in patients <60 years than (60-70) and >70 years (P value<0.05). 
 
Figure 20: Preserved ejaculation after 3 months of the studied groups. 

 
31 
 
Figure 21: Preserved ejaculation after 6 months of the studied groups. 
  

 
32 
Table 12: Relation between size of prostate groups and (preservation of 
ejaculation and rate of complications) 
 
≤60 ml 
(n=51)
 
>60 ml 
(n=33)
 
P value
 
RR (95% 
CI)
 
Preserved 
ejaculation
 
After 3 months
 
25 (49.02%)
 
18 (54.55%)
0.621
 
0.9(0.59:1.37)
 
After 6 months
 
25 (49.02%)
 
17 (51.52%)
0.823
 
0.95(0.62:1.47)
 
 
 
(n=57)
 
(n=33)
 
 
Intraoperative
 
Capsular 
perforation
 
1 (1.75%)
 
2 (6.06%)
 
0.034*
 
---
 
Intraperitoneal 
bladder perforation
0 (0%)
 
1 (3.03%)
 
Blood transfusion
 
0 (0%)
 
3 (9.09%)
 
Early 
postoperative
 
Severe irritative 
LUTs
 
5 (8.77%)
 
6 (18.18%)
 
0.488
 
---
 
Clot retention
 
3 (5.26%)
 
3 (9.09%)
 
Stress incontinence
 
2 (3.51%)
 
1 (3.03%)
 
Late 
postoperative
 
Stricture bulbar 
urethra
 
0 (0%)
 
3 (9.09%)
 
0.309
 
---
 
Bladder neck 
contracture
 
3 (5.26%)
 
0 (0%)
 
*Significantly different as P value ≤0.05, CI: Confidence interval, RR: Relative risk 
Preserved ejaculation, early and late postoperative complications were 
insignificantly different between both groups. 
Intraoperative complications were significantly lower in patients with 
prostate volume ≤60 ml than >60 ml (P value=0.034). 

 
33 
 
Figure 22: Preserved ejaculation after 3 months of the studied groups. 
 
Figure 23: Preserved ejaculation after 6 months of the studied groups. 
 

 
34 
 
Figure 24: Complications of the studied groups. 
  

 
35 
Table 13: Role of volume of prostate in prediction of preservation of 
ejaculation after 6 months 
Cut-off
 
Sensitivity
 
Specificity
 
PPV
 
NPV
 
AUC
 
P value
 
>57
 
50%
 
57.14%
 
53.8%
 
53.3%
0.520
 
0.749
 
PPV: positive predictive value, NPV: negative predictive value, AUC: area under the curve. 
Volume of prostate can’t predict preservation of ejaculation after 6 
months (P = 0.749 and AUC = 0.520) at cut-off >57 with 50% sensitivity, 
57.14% specificity, 53.8% PPV and 53.3% NPV. 
 
Figure 25: Role of volume of prostate in prediction of preservation of 
ejaculation after 6 months.

 
36