Is Cystolitholapaxy Sufficient in Patients With Bladder Stones Secondary to Benign Prostatic Obstruction?

To question the necessity of simultaneous benign prostatic obstruction (BPO) intervention with cystolitholapaxy in patients with bladder stone (BS) due to BPO and to investigate the factors predicting secondary intervention.

A total of 235 male patients over 40 years of age who underwent cystolitholapaxy, had a follow-up period longer than 12 months, and were thought to have BS secondary to BPO were included in the study.

A total of 190 patients who did not require additional intervention were defined as Group 1, and 45 patients who required secondary intervention were defined as Group 2. Secondary surgical intervention was required at a rate of 19.5% with an average follow-up of 49 months. Mean peak urine flow rate (Q_max) was 11 m/s in Group 1 and 8.6 m/s in Group 2 (p < 0.001), postvoid residual urine volume (PVR) was 85.5 mL in Group 1 and 115.3 mL in Group 2 (p < 0.001), International Prostate Symptoms Score (IPSS) was 16.7 in Group 1 and 21.7 in Group 2 (p < 0.001). Total prostate volume (TPV) (p = 0.015) and serum prostate-specific antigen (PSA) (p = 0.005) were also significantly higher in Group 2. In the multivariable Cox proportional hazards regression analysis of factors predicting secondary intervention in patients undergoing cystolitholapaxy, low Q_max (hazard ratio (HR) = 0.905, 95% confidence interval (CI): 0.821-0.997, p = 0.043), high PVR (HR = 1.014, 95% CI: 1.007-1.022, p < 0.001), high IPSS (HR = 1.178, 95% CI: 1.106-1.255, p < 0.001) and high PSA (HR = 1.086, 95% CI: 1.000-1.178, p = 0.05) were found to be predictors.

In patients with BS secondary to BPO, performing cystolitholapaxy offers a high likelihood of avoiding secondary intervention. Low Q_max, high PVR, high IPSS, and high PSA are indicators of a higher risk of secondary intervention in the preoperative period. Therefore, in a patient-centered approach, these predictors should be taken into account when deciding whether BPO surgery is necessary in addition to cystolitholapaxy.