Keywords: benign prostatic hyperplasia; robotic waterjet ablation; ejaculatory dysfunction

Background: Robot waterjet ablation (RWJA) is a minimally invasive heat-free technique for treating benign prostatic hyperplasia (BPH). Unlike traditional surgical procedures for BPH, like transurethral resection of the prostate (TURP), RWJA is designed to limit damage to surrounding ejaculatory structures to preserve antegrade ejaculation. Prior clinical trials have demonstrated favorable ejaculatory function outcomes with RWJA, but real-world data remain limited.

Objective: To evaluate changes in ejaculatory function following RWJA utilizing validated questionnaires and patient-reported assessments of semen volume.

Methods: This is an ongoing, retrospective review of patients who underwent RWJA beginning on November 18, 2024. Patients were included if they completed baseline and at least one post-procedure assessment with the Male Sexual Health Questionnaire for Ejaculatory Function (MSHQ-EjD) and International Index of Erectile Function (IIEF-15). Those who were not sexually active at baseline or who were catheter-dependent were not included. Descriptive statistics were used to evaluate changes in questionnaire scores, with a plan for paired comparisons at study completion.

Results: 14 patients (45%, n=14/31) have completed baseline questionnaires. Of these, three did not complete follow-up questionnaires, four are awaiting their first follow-up visit, two were not sexually active at baseline, and one was catheter-dependent. In total, four patients had complete data for analysis. The median time to first follow-up was 63.5 days. Median baseline MSHQ-EjD and IIEF-15 were 8.5 and 47, respectively. At follow-up, these declined to a median of 7 and 31. One patient developed de novo erectile dysfunction, and 2 patients reported a subjective decrease in their ejaculatory volume. MSHQ-EjD bother scores increased from a median of 2 at baseline to 3.5 at follow-up.

Conclusions: While the present results demonstrate some decline in sexual function scores, interpretation is limited by small sample size. Ongoing data collection will build on existing results and allow for valid comparisons.