Introduction: Lower urinary tract symptoms are a growing problem in men over 50 years old and they are often related to Benign Prostatic Hyperplasia (BPH). Retrograde ejaculation is a major pitfall of BPH surgical treatment. To overcome this pitfall, Madigan described, in 1990, a simple prostatectomy with preservation of prostatic urethra for large benign prostate. With this technique higher rates of post-operative antegrade ejaculation were achieved. Later, laparoscopic and robot-assisted techniques were also developed and published with solid benefits in terms of blood loss, bladder irrigation, bladder catheterization time, hospital stay and, more relevantly, ejaculatory function. With urethra-sparing technique, post-operative anterograde ejaculation rates were as high as 81%.
However, according to data, urethra-sparing simple prostatectomy is only being performed for large size prostates (>80-100g). There is no record of applying urethra-sparing simple prostatectomy to average size prostate (30-80g).
Methods: We present a laparoscopic urethra-sparing simple prostatectomy performed in a patient with a 50g prostate (transrectal ultrasound) willing to undergo BPH related surgery and wishing maintaining anterograde ejaculatory function
Results: With the use of this technique on an average size prostate, all the previously named benefits were achieved, namely anterograde ejaculatory function.
Conclusions: Although currently excluded from the main BPH average size prostate surgical management algorithms, we strongly believe this technique may be a paradigm shift in surgical management of bothering LUTS in patients with prostates 40-100g, wishing to preserve normal ejaculatory function.