Ejaculation-Sparing HoLEP Melbourne
Ejaculation-sparing HoLEP is a refined Holmium Laser Enucleation of the Prostate technique that relieves the urinary obstruction of benign prostatic hyperplasia (BPH) while preserving antegrade ejaculation in the majority of men. By protecting the bladder neck and the supramontanal tissue around the verumontanum, Dr Dias is able to deliver the durable symptom relief of HoLEP without the near-universal retrograde ejaculation seen with the standard technique.
Written and clinically reviewed by Dr Brendan Dias
Consultant Urologist & Robotic Surgeon · MBBS, MS (General Surgery), DrNB (Urology), IntFRCS (England), FUSANZ, FRACS (Urology)
Last clinically reviewed: 26 August 2026
Benefits
- Preserves antegrade ejaculation in approximately 60–80% of carefully selected men
- Same durable improvement in urinary flow and symptom scores as HoLEP
- Suitable for prostates of all sizes, including large glands
- Minimal blood loss — safe option for men on blood thinners
- Day Case or short overnight stay
- Tissue available for histology to exclude incidental cancer
- Low retreatment rates compared to other BPH procedures
The Procedure
The procedure is performed under general or spinal anaesthesia using a holmium laser passed through an endoscope. Rather than enucleating the entire transition zone down to the surgical capsule, Dr Dias preserves a cuff of tissue at the bladder neck and a wedge of supramontanal tissue around the verumontanum — the anatomical structures responsible for closing the bladder neck during ejaculation. The remaining obstructing adenoma is then enucleated, pushed into the bladder and morcellated for removal. The technique requires careful patient selection and an experienced HoLEP surgeon to balance maximum tissue removal with ejaculatory preservation.
Who Is a Candidate?
Ejaculation-sparing HoLEP is best suited to younger or sexually active men with bothersome BPH symptoms who place a high value on preserving antegrade ejaculation. Men with very large prostates, a large obstructing median lobe arising from the bladder neck, or those who prioritise the absolute maximum symptom relief may be better served by standard HoLEP. Dr Dias will use your symptom score, flow rate, prostate volume, MRI and personal priorities to recommend the most appropriate technique.
Recovery
Recovery is essentially the same as standard HoLEP — Day Case or single overnight stay, a urinary catheter for 1–2 days, immediate improvement in flow once the catheter is removed, and return to normal activities within 2–3 days. Mild burning and blood in the urine settle within 1–2 weeks. The key difference is sexual function: the majority of appropriately selected men retain antegrade ejaculation, although ejaculate volume may be reduced. Sensation of orgasm and erectile function are not affected by the procedure.
Risks & Considerations
Risks are similar to standard HoLEP and include urinary tract infection, transient stress incontinence, urethral stricture, bleeding and a small risk of needing further treatment. Specific to the ejaculation-sparing technique, a smaller volume of tissue is removed, so symptom relief may be marginally less than maximal HoLEP, and a small additional risk of needing a redo procedure exists. Approximately 20–40% of men will still develop retrograde ejaculation despite the modified technique. Dr Dias will discuss these trade-offs during your consultation.