Ejaculation-sparing GreenLight anatomical PVP versus REZŪM for benign prostatic obstruction surgery with an ejaculation-sparing purpose: what are the early differences?

Background Surgery for benign prostatic obstruction (BPO) is often associated with postoperative ejaculatory dysfunction. Traditional techniques like transurethral resection of the prostate (TUR-P) or open prostatectomy (OP) effectively relieve lower urinary tract symptoms (LUTS) but usually compromise antegrade ejaculation. Minimally invasive surgical techniques (MISTs), such as Rezūm® or modified endoscopic surgeries, like the ejaculation-sparing anatomical photoselective vaporization of the prostate (ESa-PVP), were developed to preserve sexual function while ensuring symptom relief. However, few comparative data are available. Our study aims to compare the early functional and sexual outcomes of Rezūm® and ESa-PVP in BPO.Methods This prospective, non-randomised study analysed two cohorts of men with LUTS unresponsive to medication or an indwelling catheter, surgically treated at our centre between December 2022 and December 2023. The primary outcome of the study was the assessment of postoperative antegrade ejaculation. Secondary outcomes included LUTS evaluation and surgical complications. Postoperative outcomes were assessed after three months by administering validated questionnaires: International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5), and Male Sexual Health Questionnaire–Ejaculatory Dysfunction, short form (MSHQ-EjD).Results A total of 54 patients were evaluated (31 Rezūm, 23 ESa-PVP). After three months, the ESa-PVP showed a better improvement of both IPSS scores (p = 0.009) and patient-perceived quality of life (p = 0.008). No significant differences were found in erectile function (IIEF-5 scores, p = 0.340), while the MSHQ-EjD scores were significantly higher in the Rezūm group (p = 0.001). Ejaculation was maintained in 26 out of 31 (83%) Rezūm patients versus 14 out of 23 (60%) ESa-PVP patients (p = 0.056).Conclusions Rezūm® and ESa-PVP are both effective and safe procedures for the treatment of BPO. While the ESa-PVP seems to provide better symptom relief in the short term, Rezūm® showed higher rates of immediate antegrade ejaculation preservation. Personalised counselling is crucial to achieve optimal patient satisfaction.