One of the biggest concerns for patients facing surgery for benign prostatic hyperplasia (BPH) is changes in sexual function after the operation. It is not uncommon for patients to hesitate about treatment after hearing that surgery might lead to an inability to ejaculate. In fact, among the functional changes that can occur after BPH surgery, patients are known to be more sensitive to ejaculatory function than erectile function.
According to the medical community, the likelihood of BPH surgery itself impairing erectile function is very low. However, with conventional surgical methods, during the process of widely resecting the hypertrophied prostatic tissue, retrograde ejaculation could occur, where semen does not exit through the urethra but flows backward into the bladder. As a result, while urinary symptoms improve, a significant number of patients feel that ejaculation has disappeared.
To overcome these limitations, a treatment strategy that has recently gained attention is Hood Sparing (verumontanum tissue preservation) Aquablation. Aquablation is a surgical method that uses a high-pressure waterjet and a robotic system to resect hypertrophied tissue. Its primary advantages include minimal thermal damage and the ability to precisely control the resection area. Applying the 'Hood Sparing' concept, the core objective is to protect the anatomical structures directly related to ejaculatory function.
In the Hood Sparing technique, the 'Hood' refers to the structures surrounding the verumontanum, which is the entrance where ejaculation begins. Recent research suggests that the key to maintaining ejaculatory function lies not so much in preserving the bladder neck, but rather in how accurately the delicate tissues near the verumontanum are preserved. Indeed, in clinical practice, cases have been observed where normal ejaculation is maintained even when the bladder neck has been widely resected, provided that the periverumontanal tissue is preserved.
Thus, a significant advantage of Aquablation is its ejaculatory function preservation rate, which reaches approximately 90%. The Hood-sparing (verumontanum tissue preservation) technique is centered on preserving about 0.5 to 1 cm of tissue around the verumontanum, where the ejaculatory ducts are located. For younger patients or those for whom sexual activity is important, treatment that considers not only improved urination but also overall quality of life is paramount.
Dr. Ryu Kyung-ho, director of Goldman Urology Gangnam Branch, stated, “I recently presented the clinical results of Hood Sparing Aquablation at the Korean Urological Association's BPH Treatment Podium Session (Podium Session 14 LUTS/BPH).” He added, “In that presentation, compared to conventional Aquablation, the ejaculatory function preservation rate was significantly improved, the incidence of retrograde ejaculation was remarkably reduced, and the improvement in urinary symptoms was equally maintained.”
As such, BPH surgery is evolving to a stage where both the patient's physiological function and satisfaction must be considered. Above all, the effectiveness of Hood Sparing Aquablation is maximized when supported by precise resection mapping and a thorough anatomical understanding.
However, despite these advantages, Hood Sparing Aquablation is not a universally applicable surgery for all patients. Firstly, the surgical strategy may vary depending on the size of the prostate, the pattern of hypertrophy, anatomical structure, and the patient's existing urinary function status. Furthermore, differences in outcomes can arise depending on how accurately the periverumontanal tissue is identified and preserved. Therefore, comprehensive imaging evaluation before surgery, along with the judgment of medical staff highly experienced in this technique, is essential.
Dr. Ryu Kyung-ho emphasized, “Patients facing BPH surgery should not merely consider whether to undergo the operation, but comprehensively evaluate the possibility of preserving ejaculatory function alongside urinary improvement, the characteristics and limitations of the surgical method, and the clinical experience of the medical team.” He concluded, “In the field of BPH treatment, we are now entering an era of precise treatment that simultaneously protects men's functional recovery and quality of life, and within this trend, Hood Sparing Aquablation is being evaluated as a meaningful option.”