One of the most common concerns among patients preparing for surgery for benign prostatic hyperplasia (BPH) is the possibility of changes in sexual function after the procedure. In particular, many patients hesitate to undergo treatment because they have heard that ejaculation may no longer occur after surgery. In fact, among the functional changes that can occur after BPH surgery, patients tend to be more sensitive about ejaculation than erectile function.
According to medical research, the likelihood that BPH surgery itself will significantly impair erectile function is very low. However, with traditional surgical approaches, retrograde ejaculation can occur. During the process of widely removing enlarged prostate tissue, semen may flow backward into the bladder rather than being expelled through the urethra. As a result, although urinary symptoms improve, some patients feel that ejaculation has disappeared.
To address this limitation, a treatment strategy that has recently gained attention is Hood Sparing aquablation. Aquablation is a surgical technique that removes enlarged prostate tissue using a high-pressure waterjet combined with a robotic system. One of its key advantages is that it minimizes thermal damage and allows highly precise control of the resection area. The Hood Sparing concept is applied to protect anatomical structures closely related to ejaculatory function.
In this context, the term “hood” refers to the structures surrounding the verumontanum, which is the anatomical region where ejaculation begins. Recent studies suggest that preservation of ejaculatory function depends less on protecting the bladder neck and more on accurately preserving the delicate tissues around the verumontanum. Clinical observations have shown that even when the bladder neck is widely resected, normal ejaculation can still be maintained if the tissue around the verumontanum is preserved.
One of the advantages of aquablation is that the preservation rate of ejaculatory function has been reported to reach approximately 90 percent. The Hood Sparing technique focuses on preserving about 0.5 to 1 cm of tissue around the verumontanum, where the ejaculatory ducts are located. For younger patients or those who consider sexual activity an important part of their quality of life, treatment strategies that improve urinary symptoms while preserving sexual function are particularly meaningful.
Dr. Ryu Kyung-ho of Goldman Urology Clinic Gangnam Branch recently presented clinical results of Hood Sparing aquablation at the Podium Session 14 LUTS/BPH session of the Korean Urological Association meeting. According to the presentation, compared with conventional aquablation, the Hood Sparing technique significantly improved ejaculatory preservation rates and markedly reduced the incidence of retrograde ejaculation, while maintaining equivalent improvements in urinary symptoms.
The evolution of BPH surgery now reflects a growing emphasis on preserving physiological function and patient satisfaction. Hood Sparing aquablation, in particular, achieves its full potential when precise resection mapping and a detailed understanding of prostate anatomy are applied during surgery.
Despite these advantages, Hood Sparing aquablation is not suitable for every patient. Surgical strategy may vary depending on factors such as prostate size, the pattern of enlargement, anatomical structure, and the patient’s baseline urinary function. In addition, outcomes may differ depending on how accurately the tissue surrounding the verumontanum can be identified and preserved during surgery. Therefore, thorough preoperative imaging evaluation and the judgment of an experienced surgeon familiar with the technique are essential.
Dr. Ryu emphasized that patients considering BPH surgery should not focus solely on whether to undergo the procedure. Instead, they should consider multiple factors, including the likelihood of urinary improvement, the possibility of preserving ejaculatory function, the characteristics and limitations of each surgical technique, and the clinical experience of the surgeon. He noted that BPH treatment is entering an era of precision care that aims to preserve both functional recovery and quality of life, and within this context, Hood Sparing aquablation is emerging as a meaningful treatment option.