Prostatic urethral lift in young men seeking preservation of ejaculatory function and fertility-related parameters: semen analysis up to 18 months and comparative review of MIST.

BACKGROUND

Minimally invasive surgical therapies (MIST) aim to relieve lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) while preserving sexual and ejaculatory function. We prospectively assessed semen parameters up to 18 months after prostatic urethral lift (PUL) in men under 50 prioritizing ejaculation and contextualized these findings against other MIST.

METHODS

In this single-center cohort (N.=20), semen analyses (according to WHO 6th edition) were performed at baseline, 6, and 18 months after PUL. Functional outcomes were prospectively collected through uroflowmetry with post-void residual (PVR) measurement, and subjective outcomes through the International Prostate Symptom Score (IPSS) questionnaire.

RESULTS

No statistically significant deterioration of semen parameters were observed (median total sperm count at timepoints: 29.5→31.0→30.5 million/mL; P=0.88), as well as for ejaculate volume and pH. Motility, vitality, and morphology remained within reference thresholds. LUTS improved durably (Qmax +67%, PVR -50%, IPSS -60%). Complications and re-treatment rates were 15% (one had prostatitis treated with antibiotic therapy, one patient required a bladder catheter for 7 days due to acute urinary retention) and 10% (one for LUTS e one for calcification of device) respectively. Notably, this series is the first to report two cases of successful paternity following PUL.

CONCLUSIONS

In carefully selected young men, PUL did not result in a deterioration of the semen quality and ejaculation through 18 months while providing durable symptom relief. To our knowledge, this is the first report of successful paternity following PUL. Ejaculation-sparing MIST should be central to counseling for fertility-conscious patients.