A novel metal-free sling approach for benign prostatic hyperplasia: early results of the Progator procedure with high ejaculatory preservation

Background: Benign prostatic hyperplasia (BPH) is highly prevalent among older men and frequently leads to bothersome lower urinary tract symptoms (LUTS). Current minimally invasive surgical therapies (MISTs) have improved safety but often involve metal implants or variable ejaculatory preservation. This study aims to evaluate the preliminary safety and efficacy of the Progator procedure, a novel metal-free mechanical MIST for BPH, which uses a transurethral sling with dynamic tension adjustment to compress enlarged prostate lobes. Methods: A single-center, retrospective cohort study was conducted involving 94 patients with moderate-to-severe BPH who underwent the Progator procedure between January and May 2025. Outcome measures included changes in International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), post-void residual (PVR) volume, and ejaculatory function at 12 weeks postoperatively. Statistical analyses used paired t-tests or Wilcoxon signed-rank tests for continuous variables and McNemar’s test for categorical variables, with significance set at P<0.05. Results: Significant improvements were observed in all primary outcomes. Mean total IPSS decreased from 29.0 to 14.0 (−55.0%; P<0.001), and Qmax increased from 11.8 to 18.5 mL/s (+57.0%; P<0.001). Ejaculatory function was preserved in 89.4% of patients. No serious adverse events (Clavien-Dindo grade ≥ III) were documented. Conclusions: The Progator procedure demonstrates significant short-term improvements in urinary symptoms and flow parameters while maintaining high rates of ejaculatory preservation. Its metal-free, adjustable-tension design offers a promising minimally invasive alternative for BPH management. Further prospective randomized studies with longer follow-up are warranted to confirm these findings.