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Updated: Nov 4, 2025
Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate HoLEP.
Published on: March 6, 2018
Differences in surgical and functional outcomes in benign prostate hyperplasia patients with only lower urinary tract
Yu Xi Terence Law1, Daniele Castellani2, Lucio Dell'atti2
1Department of Urology, National University Hospital, Singapore.
Aims:
To evaluate outcomes after benign prostate hyperplasia (BPH) surgery among men with lower urinary tract symptoms (LUTS) only versus those with urinary retention (UR).
Methods:
The protocol was registered in PROSPERO with ID#232253. Eligible studies identified from four electronic databases. Search, data extraction and quality assessment were performed independently by two reviewers. Studies with perioperative, functional, early and late complication outcomes included.
Results:
Twenty-five studies, 14 593 patients including 1 randomized controlled trial, 11 prospective and 13 retrospective studies included for meta-analysis. This showed higher risk of immediate transient recatherization (risk ratio [RR]: 5.29, p < 0.00001), longer days to trial-off-catheter (mean difference [MD]: 0.25, p < 0.00001), longer hospitalization stay in the UR group (MD: 0.35, p < 0.00001), and higher risk of intraoperative blood transfusions (RR: 1.90, p = 0.002), postoperative urinary tract infections (RR: 1.49, p < 0.00001) and sepsis (RR: 8.15, p = 0.009) too. Failure of surgery like permanent recatheterization (RR: 5.27, p < 0.00001) was more in preoperative UR group. Negligible differences seen in long term functional outcomes between the two groups (International Prostate Symptom Score at 12 months, MD: -0.06, p = 0.68; Quality of Life at 12 months, MD: 0.20, p < 0.00001; maximum urinary flow rate at 12 months, MD: -0.33, p = 0.10; and postvoid residual volume at 12 months, MD: 4.32, p < 0.00001).
Conclusions:
Preoperative UR patients undergoing surgery for BPH have higher risk of postoperative complications versus LUTS only group including the need for permanent catheterization. Both groups had similar long-term functional outcomes. We could infer that patients with UR on whom surgery is successful, with time may recover bladder function akin to patients with LUTS alone.
