Dr. Cho Jung-ho, Director of the Gangnam branch of Goldman Urology Clinic, explained that traditional surgery for benign prostatic hyperplasia (BPH) has primarily focused on removing enlarged prostate tissue to widen the urethra and improve urinary function. However, during this process, surrounding structures such as the verumontanum and ejaculatory ducts—responsible for preventing semen from flowing backward into the bladder—have often been damaged.
This damage is considered one of the main causes of retrograde ejaculation. Although it does not directly affect sexual desire or erectile function, it can cause psychological distress for patients who wish to maintain normal sexual activity.
In recent years, prostate surgery has evolved beyond simply improving urinary symptoms and has begun to focus more broadly on preserving functional outcomes and overall quality of life. In particular, emerging medical research suggests that preserving structures around the verumontanum is more important for maintaining ejaculation function than preserving the bladder neck. Increasingly, medical consensus indicates that ejaculation function depends largely on the preservation of the delicate anatomical structures surrounding the verumontanum.
A study applying this concept in clinical practice has recently attracted attention. At the Korean Urological Association Annual Meeting 2025 (KUA 2025), Dr. Cho Jung-ho presented research titled “Hood-Sparing Aquablation for BPH: A Novel Strategy to Preserve Antegrade Ejaculation in a Korean Single-Center Cohort,” introducing a new surgical approach for treating BPH.
According to Dr. Cho, the study demonstrated promising clinical outcomes using the Hood-Sparing Aquablation technique. This procedure uses a robotic waterjet system to precisely remove enlarged prostate tissue with a high-speed stream of water. At the same time, the key principle of the technique is to carefully preserve the “hood” structure around the apex of the prostate, which is closely related to ejaculation function.
By utilizing the force of water, the procedure minimizes unnecessary damage to surrounding tissues while allowing precise control over the depth and range of tissue removal. This approach helps preserve the anatomical structures around the verumontanum that allow semen to be expelled through the normal pathway.
Based on a single-center clinical study involving 122 sexually active men between 2022 and 2025, Dr. Cho reported that the ejaculation preservation rate three months after surgery reached 92.2% among patients who underwent Hood-Sparing Aquablation. This represents a significant improvement compared with the 82.6% ejaculation preservation rate observed with conventional Aquablation procedures.
The study also reported a notable reduction in the incidence of retrograde ejaculation. The rate decreased from 17.4% to 7.8%, nearly halving the occurrence of this complication and suggesting a meaningful improvement in postoperative quality of life for patients. Importantly, the improvement in urinary symptoms showed no statistically significant difference between the two groups, confirming that the technique preserves ejaculation function without compromising urinary outcomes.
Dr. Cho emphasized that the technique does not simply reduce the amount of tissue removed. Instead, it focuses on precisely preserving the apex region where the verumontanum and ejaculatory ducts are connected, allowing semen to follow its natural pathway during ejaculation. He noted that this delicate surgical approach plays a crucial role not only in preserving ejaculation function after surgery but also in significantly improving patients’ overall quality of life.