Histological changes of the prostate, which can lead to benign prostatic hyperplasia (BPH), affect up to 80% of men by age 80. They can cause troublesome urinary symptoms and often affects sexual function. HoLEP surgery is a highly effective, size-independent treatment that removes obstructive prostate tissue. But how does it affect a man’s sex life?

Researchers systematically reviewed studies published between 2000 and 2025. They found that HoLEP has a neutral to modestly favorable effect on erectile function (EF). Any temporary decline in erections during the first month after surgery usually returns to pre-surgery levels within three to six months.

In contrast, retrograde ejaculation—where semen goes into the bladder instead of out through the penis—occurs in 74% to 78% of men after standard HoLEP. However, most patients tolerate this change well. One study reported that over 70% of affected men accepted the loss of antegrade ejaculation because their urinary symptoms improved dramatically. Other research also found that retrograde ejaculation did not significantly reduce overall sexual satisfaction for most men.

The review compared HoLEP to other BPH surgeries, such as transurethral resection of the prostate (TURP). For erectile function, HoLEP was similar to these other procedures. For ejaculation, the rates of retrograde ejaculation were also comparable across different techniques.

Some surgical modifications, such as preserving the bladder neck or tissue near the verumontanum, have been tested to preserve antegrade ejaculation. While some studies report lower rates of retrograde ejaculation with these methods, results vary widely and no standardized approach has been established.

The study concludes that HoLEP is a durable and effective treatment for BPH with a strong safety profile for erectile function. Although retrograde ejaculation is common, most men accept it when their urinary symptoms are well controlled. The work titled "Erectile and ejaculatory outcomes after holmium laser enucleation of the prostate: A comprehensive narrative review" was published in UroPrecision (published on 10 September 2025).

DOI：10.1002/uro2.70030