Benign Prostatic Hyperplasia (BPH) is a representative urological disease commonly observed in middle-aged men, causing various voiding discomforts such as frequent urination, nocturia, and a sensation of incomplete emptying, thereby significantly diminishing the quality of daily life. While surgical treatment is effective in improving symptoms, it is not uncommon for many patients to postpone treatment decisions due to concerns about a decline in sexual function after surgery, particularly the loss of ejaculatory function.
Conventional prostatic hyperplasia surgery has primarily focused on widening the obstructed urethra to restore voiding function. However, in this process, there was a possibility of damage to surrounding tissues, such as the verumontanum and ejaculatory ducts, which are directly involved in semen discharge. This could lead to retrograde ejaculation, irrespective of libido or erectile function, and has consequently imposed a significant psychological burden on patients who are sensitive about maintaining their sexual life.
Recently, prostate surgery has been evolving towards 'function preservation,' moving beyond merely improving voiding function to comprehensively consider the patient's overall quality of life. Particularly within the medical community, research findings are being reported that highlight the greater importance of preserving periverumontanal structures rather than the bladder neck when aiming for ejaculatory function preservation. A medical consensus is thus forming that ejaculatory function is dependent on 'meticulous preservation of periverumontanal structures,' not the bladder neck.
Amidst this trend, research findings presented by domestic medical professionals, offering clinical evidence, have been announced and are drawing significant attention. Director Jo Jeong-ho of Goldman Urology Clinic unveiled the clinical outcomes of 'Hood-Sparing Aquablation' at the Korean Urological Association 2025 Annual Meeting (KUA 2025), thereby presenting the possibility of a new standard for prostatic hyperplasia surgery.
'Hood-Sparing Aquablation' is a robotic surgical technique that utilizes a high-velocity waterjet to precisely resect only the hyperplastic prostatic tissue. The core of this technique lies in minimizing damage to surrounding tissues by preserving the 'Hood structure' at the prostatic apex, which is directly involved in semen discharge. It is explained that because the procedure uses water pressure, the depth and scope of resection can be precisely controlled, allowing for the safe preservation of periverumontanal structures.
Director Jo Jeong-ho revealed the results of a single-center study conducted from 2022 to 2025, involving 122 sexually active men. The study showed that the ejaculatory function preservation rate was 92.2% three months after surgery. This represents a 10 percentage point improvement compared to the preservation rate of conventional Aquablation, which stands at 82.6%.
The incidence of retrograde ejaculation was also confirmed to have decreased by nearly half, from 17.4% to 7.8%. Director Jo explained, "While ejaculatory function is preserved, the voiding improvement effect is maintained equivalently to conventional surgical methods," adding that there was no statistically significant difference in voiding improvement outcomes between the two groups.
He emphasized, "The Hood-Sparing technique is not merely about reducing the resection volume; it is a surgical technique that precisely preserves the Apex region, where the verumontanum and ejaculatory ducts are connected, thereby helping semen be discharged through the normal pathway." He added, "This will serve as a new alternative for patients concerned about sexual function after prostatic hyperplasia treatment."