Personalizing BPH Management: Bladder Stone Removal Alone vs. With Concomitant Laser Enucleation-A Multicenter...

Area of Science:

• Urology
• Surgical Innovation
• Patient-Centered Care

Background:

• The necessity of combining bladder stone removal with surgical treatment for benign prostatic hyperplasia (BPH) is debated.
• This study compares the efficacy and safety of bladder stone removal with and without concomitant outlet surgery in BPH patients.

Purpose of the Study:

• To compare outcomes of bladder stone removal alone versus combined with holmium laser enucleation of the prostate (HoLEP) in BPH patients.
• To evaluate complications, stone recurrence, symptom burden, and long-term satisfaction.

Main Methods:

• A multicenter ambispective cohort study included BPH patients with bladder stones >1 cm.
• Compared 'stone removal-only' (n=63) with 'HoLEP' (n=42) groups.
• Outcomes assessed: 90-day complications, stone recurrence, IPSS scores, and decisional regret.

Main Results:

• Stone removal alone had higher recurrence (14% vs 0%) but lower overall (13% vs 31%) and major complication rates (0% vs 5%) compared to HoLEP.
• Despite differences, 77% of the 'stone removal-only' group remained free of BPH surgery at 3 years with higher satisfaction.
• A shared decision-making tool (PreOp Decision) was developed.

Conclusions:

• Bladder stone removal alone is a viable option for selected BPH patients.
• BPH surgery decisions should be guided by obstruction severity, not solely by stone presence.
• Shared decision-making, potentially aided by a validated questionnaire, is crucial for treatment selection.