Does BPH (Prostate Enlargement) Surgery Affect Sexual Function? HoLEP and Rezum
Does benign prostatic enlargement (BPH) surgery impair erection or ejaculation? The effects of HoLEP laser, Rezum water vapour and classic methods on sexual function explained.
Benign prostatic hyperplasia (BPH) is a condition seen in most men with age, causing urinary complaints. When surgery comes up, the concern patients most often voice is not the treatment itself but whether sexual function will be affected. This concern is legitimate and deserves open discussion. The short answer: modern methods largely preserve erection, but the effect on ejaculation varies by method.
First, separate two concepts: erection and ejaculation
To understand the effect of prostate surgery on sexual function, two distinct functions must be separated:
- Erection: in modern BPH surgery, erectile function is generally preserved; in many patients it runs similar to the pre-operative state.
- Ejaculation: the most common effect is that semen travels backwards into the bladder rather than out (retrograde ejaculation). This is harmless and usually does not remove the sensation of orgasm; however, the amount of semen expelled decreases or disappears. In patients planning to have children this should be discussed beforehand.
What is HoLEP (laser), and how does it affect sexual function?
HoLEP (holmium laser enucleation of the prostate) is a modern method in which enlarged prostate tissue is completely removed with a laser, giving effective and durable results even in large prostates. Erectile function is generally preserved. In ejaculation, however, because the tissue is largely removed, retrograde ejaculation is common. HoLEP stands out for its high effectiveness and low need for repeat treatment.
What is Rezum (water vapour), and who is it suitable for?
Rezum is a minimally invasive method that shrinks prostate tissue by delivering water-vapour energy. Its most important feature is a higher likelihood of preserving both ejaculation and erection; it is therefore considered particularly in patients with moderate enlargement who prioritise preserving sexual function. Its effect usually becomes apparent within a few weeks. In very large prostates, methods such as HoLEP may be more suitable.
Which method suits whom?
No single method fits every patient; the choice is made individually. The determining factors are:
- the size of the prostate and the severity of complaints,
- the patient's sexual-function priorities (especially the importance of preserving ejaculation),
- plans for fatherhood,
- accompanying conditions and any blood thinners used.
For example, if preserving ejaculation is a priority and the prostate is not very large, Rezum may come to the fore; if a very large prostate requires a durable, strong result, HoLEP may be more suitable. The right decision is made by discussing these priorities openly before surgery.
Is medication not an option?
Of course it is. In many patients BPH can be managed with medication without the need for surgery. However, some BPH medications can also affect ejaculation and sexual desire; so with any option, medication or surgery, sexual function should be part of the discussion. The aim is, alongside relieving urinary complaints, to respect the patient's quality of life and preferences.
Assoc. Prof. Zülfü Sertkaya practises in the field of urology and andrology in Istanbul; BPH assessments are planned with regard to sexual-function priorities and full confidentiality.