Benign prostatic hyperplasia (BPH) is a common disease among middle-aged and elderly men, causing significant daily discomfort due to symptoms such as frequent urination, nocturia, and a sensation of incomplete bladder emptying. While surgical treatment is well-known to be effective, many patients still delay or avoid treatment due to concerns about a decline in ejaculatory function after surgery.
Traditional surgical procedures primarily focused on securing the urethral lumen, but there remained a risk of damage to the verumontanum and ejaculatory ducts, which serve as the pathways for semen expulsion. This potential damage could lead to retrograde ejaculation, which has historically presented a significant psychological barrier for patients who place importance on their sexual life.
In recent times, prostate surgery has evolved beyond merely improving voiding function to embrace a direction of 'function preservation' that comprehensively considers the patient's overall quality of life. Particularly within the medical community, research findings are increasingly being reported that highlight the greater importance of preserving the periverumontanum structures compared to the bladder neck when aiming to preserve ejaculatory function. Consequently, a medical consensus is forming that ejaculatory function is dependent on the 'meticulous preservation of the fine structures surrounding the verumontanum,' rather than solely the bladder neck.
A study that applies these advanced medical principles to clinical practice has recently been published and is garnering significant attention. Dr. Jo Jung-ho, director of Goldman Urology, recently presented this research at the Korean Urological Association (KUA) 2025 Annual Meeting, under the title 'Hood-Sparing Aquablation for BPH: A Novel Strategy to Preserve Antegrade Ejaculation in a Korean Single-Center Cohort.'
Through this comprehensive study, Dr. Jo Jung-ho articulated the remarkable clinical achievements of 'Hood Sparing Aquablation.' This innovative technique precisely resects only the benign prostatic hypertrophic tissue using a high-velocity waterjet system powered by robotics. Concurrently, the fundamental core of this method lies in meticulously preserving the Hood structure of the prostatic apex, which is directly and intimately related to ejaculatory function. By leveraging the inherent power of water, unnecessary damage to surrounding delicate tissues is minimized, and through precise control over the depth and scope of resection, the critical periverumontanum structures, through which semen is expelled via its normal physiological pathway, are safely and effectively preserved.
Based on the compelling 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 an impressive 92.2% three months after surgery. This represents a remarkable improvement of 10 percentage points compared to the 82.6% ejaculatory function preservation rate observed with conventional Aquablation surgery, making it a truly noteworthy advancement.
He further stated that the significant reduction in the incidence of retrograde ejaculation is also highly noteworthy. The previously observed retrograde ejaculation incidence rate of 17.4% was dramatically reduced by more than half to 7.8%, strongly suggesting a positive and substantial impact on patients' post-operative quality of life. Furthermore, it was clearly demonstrated that there was no statistically significant difference in voiding improvement effects between the two study groups, unequivocally indicating that excellent voiding improvement effects are maintained concurrently with the superior preservation of ejaculatory function.
Dr. Jo Jung-ho elaborated, "The Hood Sparing technique is not merely about reducing the amount of tissue resected; rather, it is a sophisticated and delicate surgical maneuver that meticulously preserves the Apex region where the verumontanum and ejaculatory ducts are intricately connected, thereby facilitating the expulsion of semen through its normal anatomical pathway." He emphatically concluded, "This innovative approach plays a crucial role not only in ensuring the preservation of ejaculatory function after surgery but also in dramatically and fundamentally enhancing patients' overall quality of life."