One of the primary concerns for patients facing surgery for benign prostatic hyperplasia (BPH) is the potential change in sexual function after the procedure. It is not uncommon for patients to hesitate undergoing treatment, particularly after hearing that surgery might lead to the inability to ejaculate. In fact, among the functional changes that can occur after BPH surgery, it is known that patients are often more sensitive to changes in ejaculatory function than to erectile function.
According to the medical community, the likelihood of BPH surgery itself impairing erectile function is very low. However, with conventional surgical methods, during the process of widely resecting the hypertrophied prostate tissue, there was a possibility of retrograde ejaculation occurring, where semen does not exit along the urethra but flows backward into the bladder. As a result, many patients experience an improvement in their voiding symptoms but feel that ejaculation has disappeared.
To overcome these limitations, a treatment strategy that has recently garnered significant attention is Hood Sparing Aquablation (preservation of verumontanum tissue). Aquablation is a surgical method that utilizes a high-pressure waterjet and a robotic system to resect hypertrophied tissue. Its primary advantages include minimal thermal damage and the ability to precisely control the resection area. The key aspect here is the application of the 'Hood Sparing' concept to protect the anatomical structures directly involved in ejaculatory function.
In the Hood Sparing technique, the term 'Hood' refers to the periverumontanal structures, which correspond to the entrance where ejaculation begins (the verumontanum). Recent research suggests that the key to maintaining ejaculatory function lies not so much in preserving the bladder neck, but rather in how precisely the delicate tissues near the verumontanum are preserved. Indeed, clinical observations have confirmed cases where normal ejaculation is maintained even when the bladder neck has been widely resected, provided that the periverumontanal tissues are preserved.
Thus, a significant advantage of Aquablation is its ejaculatory function preservation rate, which reaches approximately 90%. The Hood-sparing (verumontanum tissue preservation) technique is crucial for preserving the structures where the ejaculatory ducts are located, specifically the periverumontanal tissue, by about 0.5 to 1 cm. For younger patients or those for whom sexual activity is important, treatment that considers not only voiding improvement but also overall quality of life is paramount.
Dr. Ryu Kyung-ho, director of Goldman Urology Clinic Gangnam Branch, stated, "I recently presented the clinical results of Hood Sparing Aquablation at the Korean Urological Association's BPH Treatment Podium Session (Podium Session 14 LUTS/BPH)." He added, "In that presentation, compared to conventional Aquablation, the ejaculatory function preservation rate was significantly improved, the incidence of retrograde ejaculation was remarkably reduced, and the improvement in voiding symptoms was maintained at an equivalent level."
In this way, BPH surgery is evolving into a stage where both the patient's physiological function and satisfaction must be considered. Above all, the effectiveness of Hood Sparing Aquablation is maximized when supported by precise resection mapping and a thorough anatomical understanding.
However, despite these advantages, Hood Sparing Aquablation is not a universally applicable surgery for all patients. Firstly, the surgical strategy may vary depending on the prostate size, pattern of hypertrophy, anatomical structure, and pre-existing voiding function. Furthermore, differences in outcomes can arise depending on how accurately the periverumontanal tissues are identified and preserved. Therefore, comprehensive imaging evaluation before surgery, along with the judgment of medical professionals highly experienced in this technique, is essential.
Dr. Ryu Kyung-ho advised, "Patients facing BPH surgery should not merely consider whether to undergo the procedure, but rather comprehensively evaluate the potential for ejaculatory function preservation alongside voiding improvement, the characteristics and limitations of the surgical method, and the clinical experience of the medical team." He concluded, "BPH treatment is now entering an era of precise therapy that simultaneously safeguards men's functional recovery and quality of life, and within this trend, Hood Sparing Aquablation is being recognized as a significant treatment option."