In case you missed the AUA 2025 meeting this year, here is the state of the art lecture by Dr Kevin Zorn from BPH Canada Prostate Surgical Institute. Delivered at the main plenary session with other keynote leaders in BPH, Dr Zorn takes the audience through the journey of man's understanding of male ejaculation process – and how that has evolved tremendoulsly over the past century. Through appreciation of ultrasound, real-time imagine (MRI), cystoscopy and cadavaric studies – the key anatomic structures have shifted from a focus on bladder neck contraction to the pericollicular tissues near the verumontanum -apex of the prostate. Through surgical treatment with novel Aquablation technology, the first of its kind harmonizing real-time ultrasound imaging, ultra-precise robotic execution of heat-free beam of high-pressure water to ablation and the "butterfly cut" – we now have reduced ejaculatory dysfunction for men undergoing resective surgery to 10-15%. And with its introduction to the urological community, other surgical procedures such as TURP, HOLEP, PVP, ThuLEP and other have mimicked the butterfly anatomy preservation to drastically improve preservation of ejaculation. Bottom-line – ejaculation preservation is a concern for all men (even the elderly 65+), once lost – gone forever, discussion of ejaculation function needs to be a STANDARD OF CARE during patient encounters for BPH, and finally, as of ~2020, we have better appreciation of the ejaculatory duct location in relation to the verumontanum, the ejaculatory mechanism of the LMC (longitudinal muscular collumn) which is vital for emission/expulsion.
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