Validated Assessment of Ejaculatory and Erectile Function After Unilateral “Z”-Shaped Bladder Neck Incision (ZANCLE): A Prospective Study Using the MSHQ-EjD Short Form and IIEF-5
- 1Department of Urology, San Carlo di Nancy Hospital, GVM Care and Research, 00165 Rome, Italy
Abstract
Background/Objectives: Preservation of anterograde ejaculation after transurethral incision for primary bladder neck obstruction (PBNO) has traditionally been assessed with unvalidated binary self-report. We prospectively evaluated ejaculatory and erectile function after the ZANCLE (“Z” Anatomical Needle Cut Leads Ejaculation) technique using two validated patient-reported outcome instruments, the Male Sexual Health Questionnaire–Ejaculatory Dysfunction Short Form (MSHQ-EjD-SF) and the International Index of Erectile Function-5 (IIEF-5). Methods: Forty consecutive patients undergoing ZANCLE for PBNO at a single institution were prospectively enrolled between June 2024 and July 2025. MSHQ-EjD-SF (ejaculatory function domain, items for force/volume/frequency, independent bother item) and IIEF-5 were administered at baseline and at 1, 6, and 12 months postoperatively, together with the binary anterograde-ejaculation question used in the parent cohort. Voiding parameters (Qmax, IPSS, PVR) are not described here, as they have already been reported for this technique by our group in a previously published series. Results: Median age was 41 years (IQR 35–55). The MSHQ-EjD-SF function domain score was unchanged from baseline to 12 months (10.8 ± 1.3 vs. 11.0 ± 1.1, Δ+0.2, p = 0.52), while the bother item improved significantly (1.1 ± 0.9 vs. 0.5 ± 0.6, Δ−0.6, p = 0.011). IIEF-5 total score remained stable throughout follow-up (20.1 ± 3.0 vs. 20.5 ± 2.8 at 12 months, Δ+0.4, p = 0.58). Anterograde ejaculation was preserved by binary self-report in 100% of evaluable patients at every postoperative timepoint. Conclusions: Validated instruments confirm, with greater granularity than binary self-report, that the ZANCLE technique preserves ejaculatory function domain scores and erectile function while reducing ejaculation-related bother. These preliminary findings support incorporation of MSHQ-EjD-SF and IIEF-5 into future prospective evaluations of ejaculation-sparing bladder neck surgery.
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BibTeX
@article{calarco2026validated,
title = {{Validated Assessment of Ejaculatory and Erectile Function After Unilateral “Z”-Shaped Bladder Neck Incision (ZANCLE): A Prospective Study Using the MSHQ-EjD Short Form and IIEF-5}},
author = {Alessandro Calarco and Pietro Morgia and Carlo Maria Scornajenghi and Marianna Paolillo and Pietro Viscuso and Beatrice Filippi and Antonio Tufano},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15197699},
url = {https://www.mdpi.com/2077-0383/15/19/7699},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Validated Assessment of Ejaculatory and Erectile Function After Unilateral “Z”-Shaped Bladder Neck Incision (ZANCLE): A Prospective Study Using the MSHQ-EjD Short Form and IIEF-5
AU - Alessandro Calarco
AU - Pietro Morgia
AU - Carlo Maria Scornajenghi
AU - Marianna Paolillo
AU - Pietro Viscuso
AU - Beatrice Filippi
AU - Antonio Tufano
PY - 2026
DA - 2026/10/05
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15197699
UR - https://www.mdpi.com/2077-0383/15/19/7699
AB - Background/Objectives: Preservation of anterograde ejaculation after transurethral incision for primary bladder neck obstruction (PBNO) has traditionally been assessed with unvalidated binary self-report. We prospectively evaluated ejaculatory and erectile function after the ZANCLE (“Z” Anatomical Needle Cut Leads Ejaculation) technique using two validated patient-reported outcome instruments, the Male Sexual Health Questionnaire–Ejaculatory Dysfunction Short Form (MSHQ-EjD-SF) and the International Index of Erectile Function-5 (IIEF-5). Methods: Forty consecutive patients undergoing ZANCLE for PBNO at a single institution were prospectively enrolled between June 2024 and July 2025. MSHQ-EjD-SF (ejaculatory function domain, items for force/volume/frequency, independent bother item) and IIEF-5 were administered at baseline and at 1, 6, and 12 months postoperatively, together with the binary anterograde-ejaculation question used in the parent cohort. Voiding parameters (Qmax, IPSS, PVR) are not described here, as they have already been reported for this technique by our group in a previously published series. Results: Median age was 41 years (IQR 35–55). The MSHQ-EjD-SF function domain score was unchanged from baseline to 12 months (10.8 ± 1.3 vs. 11.0 ± 1.1, Δ+0.2, p = 0.52), while the bother item improved significantly (1.1 ± 0.9 vs. 0.5 ± 0.6, Δ−0.6, p = 0.011). IIEF-5 total score remained stable throughout follow-up (20.1 ± 3.0 vs. 20.5 ± 2.8 at 12 months, Δ+0.4, p = 0.58). Anterograde ejaculation was preserved by binary self-report in 100% of evaluable patients at every postoperative timepoint. Conclusions: Validated instruments confirm, with greater granularity than binary self-report, that the ZANCLE technique preserves ejaculatory function domain scores and erectile function while reducing ejaculation-related bother. These preliminary findings support incorporation of MSHQ-EjD-SF and IIEF-5 into future prospective evaluations of ejaculation-sparing bladder neck surgery.
SN - 2077-0383
ER -