Bladder Neck Preservation During Transurethral Resection of the Prostate
Keywords:
Benign prostatic hyperplasia, Transurethral resection of prostate, TURP, Bladder neck preservation, Retrograde ejaculation, Ejaculation preservation, Lower urinary tract symptoms, IPSS, Sexual function, Postoperative complications, Urinary incontinence, Maximum urinary flow rate, Post-void residual urine, Internal urethral sphincter, Antegrade ejaculationAbstract
Background: Transurethral resection of the prostate (TURP) remains the gold standard surgical treatment for benign prostatic hyperplasia (BPH), with over 90% of patients reporting improved voiding symptoms. However, conventional TURP is associated with a high incidence of postoperative retrograde ejaculation, ranging from 70-90%, which significantly impacts sexual satisfaction and quality of life. The bladder neck, functioning as the internal urethral sphincter, plays a crucial role in maintaining antegrade ejaculation through its rich noradrenergic innervation and active contraction during ejaculation. Conventional TURP involves circumferential resection of the bladder neck tissues, which is believed to be a major contributor to postoperative ejaculatory dysfunction. Bladder neck preservation TURP represents a modification of the standard technique, whereby resection is initiated 0.5-0.8 cm away from the bladder neck, aiming to preserve the smooth muscle fibers responsible for bladder neck closure during ejaculation while maintaining adequate prostatic decompression.