By Dr. Jo Jung-ho, Director of Goldman Urology Clinic, Gangnam Branch
Traditional benign prostatic hyperplasia (BPH) surgery primarily aims to remove hypertrophied prostatic tissue, thereby expanding the urethra and improving voiding function. However, there has been a frequent incidence of damage to surrounding tissues, such as the 'verumontanum' (精丘) and 'ejaculatory ducts,' which prevent semen from flowing backward into the bladder during this process.
This damage is identified as a major cause of 'retrograde ejaculation.' While it does not directly affect libido or erectile function, it has imposed a significant psychological burden on patients who wish to maintain an active sex life.
Recently, prostate surgery has evolved beyond merely improving voiding function, moving towards a 'function-preserving' approach that comprehensively considers the patient's quality of life.
Particularly within the medical community, research findings are being reported that highlight the greater importance of preserving structures around the verumontanum, rather than the bladder neck, when aiming to preserve ejaculatory function. A medical consensus is emerging that ejaculatory function depends on the 'preservation of the delicate structures surrounding the verumontanum,' not the bladder neck.
A study applying these medical principles to clinical practice has been published and is drawing significant attention. Dr. Jo Jung-ho, Director of Goldman Urology Clinic, Gangnam Branch, recently presented a study titled 'Hood-Sparing Aquablation for BPH: A Novel Strategy to Preserve Antegrade Ejaculation in a Korean Single-Center Cohort' at the Korean Urological Association (KUA) 2025 Annual Meeting, proposing a new method for benign prostatic hyperplasia surgery.
Through this research, Dr. Jo Jung-ho articulated the outstanding clinical outcomes achieved by 'Hood-Sparing Aquablation.' This technique precisely resects only the hypertrophied prostatic tissue using a high-velocity waterjet delivered by a robotic waterjet system.
Concurrently, the key aspect is the delicate preservation of the Hood structure at the prostatic apex, which is directly associated with ejaculatory function. By utilizing the power of water, unnecessary damage to surrounding tissues is minimized, and the depth and extent of resection are precisely controlled, thereby safely preserving the structures around the verumontanum through which semen is normally expelled.
Based on the results of a single-center clinical study conducted from 2022 to 2025 involving 122 sexually active men, Dr. Jo emphasized that the ejaculatory function preservation rate for patients who underwent 'Hood-Sparing Aquablation' reached 92.2% three months post-surgery. This is a remarkable 10 percentage point improvement compared to the 82.6% ejaculatory function preservation rate of conventional Aquablation surgery.
The director also noted the significant reduction in the incidence of retrograde ejaculation. The previous retrograde ejaculation rate of 17.4% was reduced by half to 7.8%, suggesting a positive impact on patients' post-surgical quality of life. Furthermore, it was clarified that there was no statistically significant difference in voiding improvement effects between the two groups, indicating that excellent voiding improvement is maintained concurrently with ejaculatory function preservation.
Dr. Jo Jung-ho emphasized, "The technique introduced here is not merely about reducing the amount of tissue resected, but rather a delicate surgical skill that precisely preserves the apex region where the verumontanum and ejaculatory ducts connect, thereby helping semen to be expelled through its normal pathway." He added, "This plays a crucial role not only in preserving ejaculatory function post-surgery but also in dramatically improving the overall quality of life for patients."