Persistence of nocturia after BPH surgery: a multicenter study

Nocturia may be one of the most persistent and bothersome lower urinary tract symptoms (LUTS) in men treated for benign prostatic obstruction (BPO). This study aimed to evaluate the evolution of nocturia after endoscopic enucleation of the prostate (EEP) and identify predictors of no postoperative improvement.

We conducted a multicenter retrospective study of 120 men who underwent EEP for LUTS/BPO and nocturia evaluation using voiding diaries. Patients with isolated nocturia were not considered for surgery. Outcomes were categorized into complete remission, partial improvement, stability, or worsening.

At a median follow-up of 15 months, 45% of patients achieved complete remission of nocturia, 19% experienced partial improvement, 30% remained stable, and 6% worsened. The median time for improvement was 6 months. Cox regression analysis identified predominant overactive bladder symptoms as the only significant predictor of no response (HR 1.68; 95% CI, 1.01-2.82; p = 0.04). No significant association was found with age, body mass index, prostate volume, or cardiometabolic comorbidities.

This multicenter study highlights that while nocturia often persists after EEP, nearly two-thirds of patients experience meaningful improvement, emphasizing both the potential benefit of surgery and the multifactorial nature of the symptom.