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Prostatic Surgery With Preservation of the Supramonticular Tissue Versus Standard Surgery for Benign Prostatic Hyperplasia: A Systematic Review
Author(s)
Mendoza-Chuctaya, Giuston
National University of Saint Anthony the Abbot in Cuzco
Rodrigo-Ramos, Kevin
National University of Saint Anthony the Abbot in Cuzco
Taype-Rondán, Álvaro Renzo
Universidad San Ignacio de Loyola
Date Issued
2026
Type
Article
Publisher
John Wiley and Sons Inc
Volume
86
Issue
3
Series/Report No.
The Prostate
Contained in
Prostate
Start Page
377
End Page
386
ISSN
0270-4137
Abstract
Background Benign prostatic surgery is a common intervention for the treatment of benign prostatic hyperplasia (BPH). Preservation of the supramonticular tissue during surgery has been proposed as a technique that could minimize complications and improve functional outcomes, such as sexual function and urinary continence. However, evidence regarding its benefits compared to standard techniques remains limited and contradictory. Objective To compare modified surgery with supramonticular tissue preservation versus standard prostate surgery. Methods For this systematic review, we conducted searches in PubMed, Scopus, Web of Science, and the Cochrane Library. We included randomized controlled trials (RCTs) comparing modified surgery with standard surgery. Two reviewers independently selected the studies. Meta‐analyses were performed using RevMan 5.4, and the GRADE approach was used to assess the certainty of the evidence. Results We found eight RCTs with 573 participants. Meta‐analyses showed that the modified technique probably results in greater preservation of antegrade ejaculation (OR: 3.25; 95% CI: 2.56 to 4.11). However, it may have no effects on IPSS, maximum flow, QoL, post‐void residual volume (PVR), and IIEF, with very low certainty of the evidence. Conclusion In patients undergoing endoscopic surgery for BPH, surgery performed with the modified technique (supramonticular tissue preservation 1 cm above the verumontanum) probably results in increased preservation of antegrade ejaculation, and may have no effect on IPSS, maximum flow, QoL, PVR, and IIEF, with the evidence for these effects being very uncertain.