Research progress on ejaculatory function preservation in minimally invasive surgical treatments for benign prostatic hyperplasia: a narrative review

Abstract

Background and Objective: As the treatment paradigm for benign prostatic hyperplasia (BPH) shifts from solely relieving lower urinary tract symptoms (LUTS) to emphasizing quality of life and preservation of sexual function, minimally invasive surgical therapies (MISTs) have emerged as promising options for preserving ejaculatory function postoperatively. This review aims to summarize the technical features and evidence base of major MISTs, including prostatic urethral lift (PUL), prostatic artery embolization (PAE), water vapor thermal therapy (WVTT, Rezum), Aquablation, and robot-assisted simple prostatectomy (RASP), with a focus on their ability to preserve ejaculatory function. Methods: A structured literature review was conducted to identify representative studies on MISTs for BPH, with an emphasis on clinical indicators such as urinary symptom relief and preservation of ejaculatory function. Key data were extracted and summarized in a comparative table including surgical technique, efficacy, functional outcomes, advantages, disadvantages, and patient selection criteria. To assess the research attention and evidence strength of each technique, a stacked bar chart was generated illustrating the number of representative and other relevant studies per technique. Data extraction was performed independently by two reviewers and cross-checked to ensure accuracy. Key Content and Findings: Evidence indicates significant differences among MISTs in balancing urinary efficacy with preservation of ejaculatory function. Techniques such as PUL and PAE, which minimize interference with midline prostatic structures, demonstrate higher rates of ejaculatory function preservation. Rezum and Aquablation also achieve functional preservation through targeted treatment, avoiding the verumontanum. Modified RASP techniques offer new structural-sparing strategies in large glands. Despite these advantages over traditional surgery, the current evidence base is limited by small sample sizes, short follow-up periods, and heterogeneity in outcome measures. Conclusions: Future research should prioritize large-scale, multicenter randomized controlled trials with standardized evaluation of ejaculatory function to support the development of function-preserving treatment strategies. Urologists should tailor interventions based on individual patient needs while balancing symptom relief with functional outcomes to achieve patient-centered, precision therapy.