Evidence map›Paper›PMID 41964756›Full record

SynthesisWorld journal of urology2026

Ejaculation-sparing endoscopic surgery for benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials.

Carlo Giulioni, Angelo Cafarelli, Federico Falsetti, Luca Spinozzi, Pietro Piazza, Luca Orecchia, Giacomo Maria Pirola, Angelo Naselli, Martina Maggi, Michele Marchioni and 5 more

Abstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in World journal of urology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Carlo GiulioniDepartment of Urology, Casa di Cura Villa Igea, Ancona, 60127, Italy. carlo.giulioni9@gmail.com.
Angelo CafarelliDepartment of Urology, Casa di Cura Villa Igea, Ancona, 60127, Italy.
Federico FalsettiDepartment of Urology, Casa di Cura Villa Igea, Ancona, 60127, Italy.
Luca SpinozziDepartment of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
Pietro PiazzaDepartment of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
Luca OrecchiaUrology Unit, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy.
Giacomo Maria PirolaUrology Department, San Giuseppe Hospital, IRCCS Multimedica, Multimedica Group, Milan, Italy.
Angelo NaselliUrology Department, San Giuseppe Hospital, IRCCS Multimedica, Multimedica Group, Milan, Italy.
Martina MaggiDepartment of Urology, Department of Health Science, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy.
Michele MarchioniUniCamillus - Saint Camillus International University of Health and Medical Sciences, Rome, Italy.
Valentina MauriziInternal Medicine Unit Jesi, Area Vasta 2 ASUR Marche, Jesi, Italy.
Steffi Kar Kei YuenS.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.
Vineet GauharDepartment of Urology, Ng Teng Fong General Hospital, Singapore, 126817, Singapore.
Thomas R W HerrmannDepartment of Urology, Spital Thurgau AG, Kantonsspital Frauenfeld, Frauenfeld, Switzerland.
Daniele CastellaniUrology Unit, Azienda Ospedaliero-Universitaria delle Marche, Ancona, 60126, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEjaculatory dysfunction represents a major drawback of conventional endoscopic surgery for benign prostatic hyperplasia (BPH), substantially affecting postoperative quality of life. Ejaculation-sparing (ES) endoscopic techniques have been developed to preserve ejaculatory function while maintaining effective relief of lower urinary tract symptoms (LUTS).

methodsA systematic review and meta-analysis of randomized controlled trials was conducted in accordance with the PRISMA 2020 guidelines. Adult men undergoing ES endoscopic prostate surgery were compared with those treated using standard endoscopic techniques. Primary outcomes included preservation of antegrade ejaculation, Male Sexual Health Questionnaire–Ejaculatory Dysfunction (MSHQ-EjD) scores, and semen volume. Secondary outcomes comprised erectile function, urinary flow parameters, symptom scores, operative time, and postoperative complications.

resultsEight randomized trials, including 562 patients, were analyzed. ES techniques were associated with a substantially higher likelihood of preserving antegrade ejaculation compared with conventional surgery (OR 15.11, 95% CI 8.96–25.46, p < 0.0001). Ejaculatory-specific outcomes significantly favored ES surgery, with higher postoperative MSHQ-EjD scores and greater semen volume. Erectile function was preserved, with comparable International Index of Erectile Function–15 scores between groups and slightly higher IIEF-5 scores in the ES cohort. Conventional techniques demonstrated higher maximum urinary flow rates at 3 months. However, this advantage was not sustained at 6 months. Symptom scores were comparable early after surgery, but ES techniques favored them at mid-term follow-up. Operative time was shorter with ES approaches, while rates of minor and major postoperative complications were similar between groups.

conclusionsEjaculation-sparing endoscopic surgery for BPH offers a marked improvement in ejaculatory outcomes without compromising erectile function, mid-term urinary efficacy, or perioperative safety, supporting its use in appropriately selected patients prioritizing sexual function.

Indexed as

EjaculationEndoscopyOrgan Sparing TreatmentsProstatectomyProstatic HyperplasiaEjaculatory DysfunctionHumansMaleRandomized Controlled Trials as TopicAnterograde ejaculationBenign prostatic hyperplasiaEjaculation-sparing surgeryLaser surgeryTransurethral surgery of the prostate

Identifiers

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Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.