“Z” Anatomical Needle Cut Leads Ejaculation (ZANCLE): Unilateral incision for bladder neck obstruction with ejaculation-sparing intent: A single-surgeon experience

Abstract

This study aimed to evaluate functional outcomes and anterograde ejaculation rates in patients undergoing monopolar, unilateral transurethral incision of the prostate (TUIP) with “Z” shaped incision with ejaculatory sphincter sparing for primary bladder neck obstruction (PBNO) in a case series performed by a single surgeon. Between December 2018 and July 2023, data from patients who underwent monopolar, unilateral TUIP were prospectively collected. Patients with a prostate volume of less than 30 mL were included. Functional outcomes, including maximum flow rate (Qmax, mL/s), post-void residual volume (PVR, mL), International Prostate Symptom Score (IPSS), and IPSS Quality of Life (IPSS QoL) score, were assessed preoperatively and at 1, 6, and 12 months postoperatively. A total of 106 patients met the inclusion criteria, with a median age of 42 years (range: 37–57) and a median prostate volume of 27 mL (range: 20–29). The median hospital stay was 1 day, and the median catheterization time was 3 days. At 1-month follow-up, the mean Qmax increased from 10.2 ± 2.5 mL/s to 22.8 ± 3.9 mL/s, while the mean IPSS score and IPSS QoL score decreased from 16 ± 2.7 to 6.9 ± 1.5 and from 4.3 ± 0.9 to 1.9 ± 1.6, respectively (p < 0.001). The mean PVR volume decreased from 125.5 ± 16.1 mL to 27.7 ± 7.3 mL (p < 0.001). Uroflowmetry results remained statistically significant at 12 months of follow-up (each p < 0.001). Anterograde ejaculation was preserved in all cases. Unilateral monopolar TUIP confirms to be a feasible and safe procedure for the treatment of BNO in young and sexually active patients.