Benign prostatic hyperplasia (BPH) is a common urologic condition among middle-aged men, often causing urinary symptoms such as frequent urination, nocturia, and a persistent feeling of incomplete bladder emptying. These symptoms can significantly reduce quality of life. Although surgical treatment is known to be effective in improving symptoms, many patients hesitate to proceed with surgery due to concerns about postoperative sexual function, particularly the loss of ejaculation.
Traditional BPH surgeries have mainly focused on widening the obstructed urethra to restore normal urinary flow. However, during this process, nearby structures involved in semen discharge—such as the verumontanum and ejaculatory ducts—could potentially be damaged. While this does not directly affect sexual desire or erectile function, it may lead to retrograde ejaculation, which has been a major psychological concern for patients who wish to maintain normal sexual activity.
In recent years, prostate surgery has evolved beyond simply improving urinary symptoms and has increasingly focused on preserving functional outcomes and overall quality of life. In particular, growing evidence suggests that preserving the structures surrounding the verumontanum is more critical for maintaining ejaculation function than preserving the bladder neck. As a result, a new medical perspective is emerging that emphasizes the importance of protecting the delicate anatomical structures around the verumontanum.
Against this backdrop, a study presented by a Korean medical team has attracted attention by providing clinical evidence supporting this concept. Dr. Cho Jung-ho of Goldman Urology Clinic presented clinical outcomes of the “Hood-Sparing Aquablation” technique at the Korean Urological Association Annual Meeting 2025 (KUA 2025), suggesting the potential for a new standard in BPH surgery.
Hood-Sparing Aquablation is a robotic surgical technique that uses a high-speed waterjet to precisely remove enlarged prostate tissue. A key feature of the technique is the preservation of the “hood” structure at the apex of the prostate, which is directly associated with semen discharge. By using water pressure rather than heat-based energy, surgeons can precisely control the depth and extent of tissue removal while minimizing damage to surrounding tissues. This allows the anatomical structures around the verumontanum to remain intact.
Dr. Cho reported the results of a single-center study conducted between 2022 and 2025 involving 122 sexually active male patients. Three months after surgery, the ejaculation preservation rate among patients who underwent Hood-Sparing Aquablation reached 92.2%, representing an improvement of about 10 percentage points compared with the 82.6% preservation rate reported for conventional Aquablation procedures.
The incidence of retrograde ejaculation was also significantly reduced, decreasing from 17.4% to 7.8%, nearly halving its occurrence. Dr. Cho noted that the improvement in urinary symptoms remained equivalent to conventional surgical methods, with no statistically significant difference between the groups in terms of urinary outcome.
He explained that the Hood-Sparing technique does not simply reduce the amount of prostate 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. According to Dr. Cho, this approach may offer a meaningful new treatment option for patients with BPH who are concerned about maintaining sexual function after surgery.