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Ejaculation physiology and dysfunction after BPH surgery: the role of the new MISTs

Prostate Cancer and Prostatic Diseases volume 26, pages 475–482 (2023)Cite this article

Subjects

Abstract

Background

Human ejaculation can be defined as a complex and still largely unknown function. Since decades, Benign Prostatic Hyperplasia (BPH) surgery-associated loss of antegrade ejaculation has been reported as a bother by many patients. New technologies and modified surgical techniques were developed, to reduce the impact of ejaculatory dysfunction on patients’ perceived quality of life. Recently, the emerging of the new Minimally Invasive Surgical Techniques (MISTs) empowered the urological surgeons with the technological means to introduce the ejaculation-sparing principles into everyday clinical practice.

Methods

Our paper was conceived as a state-of-the-art analysis about the anatomical and physiological premises of the human ejaculation and their clinical application in the field of ejaculation-sparing surgery for the treatment of Lower Urinary Tract Symptoms (LUTS). Moreover, we proposed an innovative physiological model for antegrade ejaculation.

Results

We analysed the elements of the “ejaculatory apparatus” from an anatomical point of view. We investigated the physio-pathological models of the human ejaculation, from the classical “combustion chamber” paradigm to the new evidences by which it could be overcome. Finally, we provided a synthetic literature review about the ejaculation-sparing techniques for BPH surgery. Particularly, we distinguished them between classical techniques, modified for ejaculation-preserving purposes, and the new MISTs, characterized by the introduction of new technologies and different treatment modalities.

Conclusions

Modified surgical techniques and new technologies opened new perspectives about human ejaculation. Previously established functional paradigms were questioned and overcome by recent clinical evidence. The new MISTs gained a prominent role in the process, opening a whole new era for BPH surgery.

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Fig. 1: A human ejaculation model based on the “combustion chamber” paradigm.
Fig. 2: A novel human antegrade ejaculation model.

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Authors and Affiliations

  1. Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy

    Mattia Sibona, Paolo Destefanis, Eugenia Vercelli & Paolo Gontero

  2. Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Silvia Secco

  3. Department of Urology, Hesperia Hospital, CUrE Group, Modena, Italy

    Luca Cindolo

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MS: bibliographic research and manuscript writing; PD: manuscript writing and revision; EV: manuscript editing and image creation; SS: manuscript editing; PG: manuscript writing and revision; LC: bibliographic research, manuscript writing and revision.

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Sibona, M., Destefanis, P., Vercelli, E. et al. Ejaculation physiology and dysfunction after BPH surgery: the role of the new MISTs. Prostate Cancer Prostatic Dis 26, 475–482 (2023). https://doi.org/10.1038/s41391-023-00686-y

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