Simple Prostatectomy is an Effective Option for BPH Patients With Hypocontractile Bladders

The impact of preoperative bladder function on outcomes of simple prostatectomy (SP) is unknown. The goal of this study was to determine if detrusor contractility affects postoperative catheter-free status in patients undergoing SP for benign prostatic hyperplasia (BPH).

Patients who underwent SP (either open or minimally invasive) from 2017 to 2024 at our institution and had preoperative urodynamics were identified retrospectively. Bladder contractility index (BCI) was used to categorize patients as normocontractile (BCI ≥ 100) or hypocontractile (BCI < 100). Demographics, preoperative urodynamics, peri-operative characteristics, and postoperative variables were compared between the two groups with postoperative catheter status being the primary outcome.

Among 101 SP patients with preoperative urodynamics, 47 had hypocontractile bladders (median BCI 69 vs. 131). Both groups had similar median age, preoperative prostate specific antigen (PSA), and rates of diabetes. The majority of procedures in both the normocontracile and hypocontractile groups were robot-assisted (83% vs. 81%, respectively). Patients in the hypocontractile group were significantly more likely to be catheter dependent pre-operatively (77% vs. 57%, p = 0.04). There was no difference in preoperative prostate size or use of BPH pharmacotherapy. Overall, 97% of hypocontractile and 100% of normocontractile patients were catheter-free following surgery. There were no differences in postoperative outcomes including pathology tissue weight and post-op PSA.

This is one of the first studies assessing outcomes of SP in patients with hypocontractile bladders. SP is an effective surgical option for patients with impaired detrusor function including those who are catheter dependent.