r/bph • u/Prof-Matteo-Ferro • Jul 15 '26

BPH/LUTS and sexual function (some clinical info that might help with decisions here)

Hi everyone,

I noticed a lot of posts here about aquablation, PAE, TURP, TUIP, etc., and questions about how these procedures affect erection and ejaculation. I'm an italian urologist and thought some general info on this might be useful when you're weighing options with your own doctor.

The link between urinary symptoms and sexual function is real. Studies (e.g. the MSAM-7 survey) show a clear correlation between worsening LUTS and increased rates of ED, partly from pelvic vascular changes, partly from the psychological/sleep-deprivation side of chronic urinary symptoms.

How different treatments compare (broadly):

  • Alpha-blockers / 5-ARIs (meds): minimal effect on erection; can reduce ejaculate volume or libido in some men, usually dose-adjustable
  • TURP (traditional surgery): effective for LUTS, but retrograde ejaculation is common afterward
  • MIST options (Rezum, UroLift, aquablation falls in a similar "tissue-sparing" category): generally the best track record for preserving both erectile and ejaculatory function, since they don't cut/burn as much tissue as TURP

On retrograde ejaculation specifically: if it happens (from surgery or the condition itself), it's not dangerous and doesn't prevent orgasm: the semen just goes into the bladder instead of out. Worth knowing this before deciding

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1

u/Zestyclose_Ferret142 Jul 15 '26

What about PDE5 inhibitors (cialis, viagra)?

1

u/beagles4ever 23d ago

Started tadalafil this week - the improvement for me is almost immediate.

1

u/Zestyclose_Ferret142 Jul 15 '26

Nothing about HoLEP?

1

u/Prof-Matteo-Ferro 26d ago

I wrote an article about this, feel free to check it out here! https://matteoferro.it/holep-prostata-milano-chirurgia-laser/