Benign prostatic hyperplasia (BPH) is a common condition among middle-aged and older men and often causes significant discomfort in daily life through symptoms such as frequent urination, nocturia, and a persistent feeling of incomplete bladder emptying. Although surgical treatment is known to be highly effective, many patients still delay or avoid treatment because of concerns about reduced ejaculation function after surgery.
Traditional surgical approaches have focused primarily on widening the urethral passage to improve urinary flow. However, these procedures sometimes carried the risk of damaging structures such as the verumontanum and ejaculatory ducts, which are essential for the normal pathway of semen discharge. As a result, retrograde ejaculation could occur, creating a major psychological barrier for patients who value maintaining their sexual function.
In recent years, prostate surgery has evolved beyond simply improving urinary function and has increasingly focused on preserving overall quality of life through functional preservation. In particular, growing research within the medical community suggests that preserving the structures around the verumontanum plays a more important role in maintaining ejaculation function than preserving the bladder neck. Medical understanding is increasingly shifting toward the idea that ejaculation depends largely on the preservation of the delicate anatomical structures surrounding the verumontanum.
A study applying this concept in clinical practice has recently drawn attention. Dr. Cho Jung-ho of Goldman Urology Clinic 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 Annual Meeting 2025 (KUA 2025).
Through this research, Dr. Cho highlighted the clinical outcomes achieved with the Hood-Sparing Aquablation technique. This method uses a robotic waterjet system to precisely remove enlarged prostate tissue with a high-velocity stream of water. At the same time, the key principle of the technique is to carefully preserve the hood structure at the apex of the prostate, which is directly 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 extent of tissue removal. This approach safely preserves 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 conducted between 2022 and 2025, Dr. Cho reported that three months after surgery, patients who underwent Hood-Sparing Aquablation showed an ejaculation preservation rate of 92.2%. This represents a notable improvement of about 10 percentage points compared with the 82.6% preservation rate reported for conventional Aquablation procedures.
He also noted a significant reduction in the incidence of retrograde ejaculation. The rate decreased from 17.4% to 7.8%, nearly halving its occurrence and suggesting a meaningful improvement in postoperative quality of life for patients. Importantly, there was no statistically significant difference in urinary symptom improvement between the two groups, demonstrating that the technique preserves ejaculation function while maintaining strong urinary outcomes.
Dr. Cho emphasized that the Hood-Sparing technique does not simply reduce the amount of tissue removed. Rather, 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 explained that this delicate surgical approach plays a critical role not only in preserving ejaculation function after surgery but also in significantly improving patients’ overall quality of life.