Temporary pharmacologically induced ejaculatory dysfunction influences surgical decision-making in sexually active men with benign prostatic hyperplasia: a prospective interventional study

Purpose: The aim of this study was to evaluate whether temporary pharmacologically induced ejaculatory dysfunction influences treatment preference among sexually active men undergoing preoperative counseling for surgical management of benign prostatic hyperplasia (BPH). Methods: A prospective, single-center, exploratory interventional study was conducted including 71 sexually active men with moderate-to-severe lower urinary tract symptoms secondary to BPH who were eligible for both transurethral resection of the prostate (TURP) and water vapor thermal therapy (Rezūm). Following standardized counseling, the patients recorded their preferred treatment before and after a 4-week course of tamsulosin 0.4 mg daily. The primary analysis included patients who developed clinically relevant tamsulosin-induced ejaculatory dysfunction. Urinary symptoms, erectile function, ejaculatory function, ejaculatory bother, and the perceived importance of ejaculation were assessed using validated questionnaires. Results: Clinically relevant tamsulosin-induced ejaculatory dysfunction occurred in 35 of 71 patients (49.3%), who constituted the prespecified evaluable cohort. Among these patients, 12 (34.3%) changed their initial treatment preference following tamsulosin exposure. Nine patients switched from TURP to Rezūm, while three patients initially choosing TURP opted for conservative management. No patient changed preference from Rezūm to TURP. Overall, a significant shift away from TURP was observed after experiencing ejaculatory dysfunction (P < 0.001). Urinary symptoms and erectile function remained unchanged, whereas ejaculatory function significantly worsened, ejaculatory bother increased, and patients attributed greater importance to preserving ejaculation (P < 0.001 for all). Conclusions: Temporary pharmacologically induced ejaculatory dysfunction was associated with a significant change in treatment preference in a substantial proportion of sexually active men undergoing counseling for BPH surgery. These findings suggest that experiential exposure to reversible ejaculatory dysfunction may represent a novel, hypothesis-generating decision-support strategy, complementing conventional counseling. Further studies are needed to validate this approach and to assess its impact on actual treatment selection and long-term satisfaction.