Quick answer
Retrograde ejaculation, in which semen goes into the bladder, is very common after TURP, Greenlight and HoLEP.1,2 Rezum tends to preserve ejaculation in 80% to 90% of cases.5,6 Erections usually change little: in a review of 151 studies, the score did not change significantly.2
Why ejaculation changes
During ejaculation, the bladder neck closes and semen comes out through the urethra. Techniques that remove tissue near the neck usually leave it open. Without that closure, semen goes into the bladder and comes out later, with urine.
What to expect with each technique
| Technique | Ejaculation | Source |
|---|---|---|
| TURP | Retrograde ejaculation is very common | European guideline and review1,2 |
| Greenlight | No difference from TURP | European guideline1 |
| HoLEP | Almost never preserved | My practice, with rates similar to TURP in the guideline1 |
| Rezum | Tends to be preserved in 80% to 90% | 2026 studies5,6 |
| Aquablation | Lost in 10%, against 36% with TURP | WATER study1 |
Minimally invasive techniques had few cases of loss of ejaculation in a 2026 review:4
| Review of minimally invasive techniques | Loss of ejaculation |
|---|---|
| EchoLaser | 5% |
| Rezum | 3% |
| iTind | 1% |
| Urolift | 0% |
| Optilume | 0% |
Most of these techniques did not significantly increase retrograde ejaculation.2 The studies measure ejaculation in different ways, so the numbers cannot be compared directly.
What about erections?
In a review of 151 studies with 20,531 men, the erection score did not change significantly after surgery.2 Another review, of 33 randomized studies, found no difference between techniques up to 5 years. The exception was Urolift, with a better score than TURP at 24 months.3
How I approach it
In my practice, I ask what you want to preserve before recommending treatment. I explain that HoLEP almost never preserves ejaculation and that Rezum tends to preserve it. If it matters to you, we compare the techniques most likely to keep ejaculation, along with the symptom relief each one offers.
When to see a urologist
- If you are going to have prostate surgery and preserving ejaculation weighs on the decision
- If your ejaculation or erections changed after a treatment
- If you notice blood in your semen or pain when you ejaculate
Frequently asked questions
What is retrograde ejaculation?+
It is when semen goes into the bladder at orgasm instead of coming out through the urethra. It leaves the body later, with urine.1
Is retrograde ejaculation harmful?+
Semen in the bladder does not harm your health. The change matters for men who want to keep ejaculation as it was.
Which techniques usually cause retrograde ejaculation?+
TURP, Greenlight and HoLEP. In my practice, HoLEP almost never preserves ejaculation.1,2
Which technique preserves ejaculation?+
Rezum tends to preserve it in 80% to 90% of cases.5,6 Urolift, Optilume, iTind and Aquablation also had few cases of loss in the studies.1,4
Does prostate surgery cause impotence?+
In a review of 151 studies, the erection score did not change significantly after surgery.2 Even so, each case is different, and the subject is part of the conversation before surgery.
Do prostate medications change ejaculation?+
Some do. Alpha-blockers can change ejaculation.1
References
- EAU Guidelines on the Management of Non-neurogenic Male LUTS. European Association of Urology; 2026. Disease management chapter. EAU
- Manfredi C, García-Gómez B, Arcaniolo D, et al. Impact of Surgery for Benign Prostatic Hyperplasia on Sexual Function: A Systematic Review and Meta-analysis of Erectile Function and Ejaculatory Function. Eur Urol Focus. 2022;8(6):1711-1732. PubMed
- Light A, Jabarkhyl D, Gilling P, et al. Erectile Function Following Surgery for Benign Prostatic Obstruction: A Systematic Review and Network Meta-analysis of Randomised Controlled Trials. Eur Urol. 2021;80(2):174-187. PubMed
- Franco A, Ditonno F, Manfredi C, et al. Systematic Review and Pooled Analysis of Functional and Sexual Outcomes of Minimally Invasive Surgical Treatments for Benign Prostatic Obstruction. Eur Urol. 2026;89(4):318-331. PubMed
- Destefanis P, Sibona M, Oderda M, et al. Ejaculation-sparing GreenLight anatomical PVP versus REZŪM for benign prostatic obstruction surgery with an ejaculation-sparing purpose: what are the early differences? Minim Invasive Ther Allied Technol. 2026;35(5):383-391. PubMed
- Long Depaquit T, Berchiche W, Uleri A, et al. Two-Year Outcomes of Rezūm Therapy in Real-Life BPH Patients. Prostate. 2026;86(3):314-319. PubMed
3D illustrations: BodyParts3D, © The Database Center for Life Science, licensed under CC Attribution-Share Alike 2.1 Japan.
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