Transurethral Resection of the Prostate in Patients With Neurogenic Lower Urinary Tract Dysfunction

Transurethral resection of the prostate (TURP) remains the gold standard surgical treatment for benign prostatic hyperplasia (BPH) in neurologically intact men. However, determining when TURP is appropriate in men with neurogenic lower urinary tract dysfunction (NLUTD) remains a persistent clinical challenge due to heterogeneous neurologic conditions and variable bladder and sphincter function.

A narrative review of the literature was performed using PubMed and relevant reference lists to evaluate outcomes of TURP in men with NLUTD. Studies involving major neurologic conditions, including spinal cord injury (SCI), spina bifida, cerebrovascular accident (CVA), multiple sclerosis (MS), and Parkinson's disease (PD), were reviewed. Emphasis was placed on functional outcomes and the role of urodynamic evaluation in guiding patient selection.

Reported outcomes following TURP in men with NLUTD vary considerably and depend largely on the underlying neurologic diagnosis and the degree of preserved detrusor contractility and sphincteric function. Across all neurologic conditions, preoperative urodynamic evaluation is critical to identify patients most likely to experience symptomatic improvement while minimizing the risk of postoperative urinary incontinence, persistent retention, or voiding failure.

Baseline detrusor function and the presence of true bladder outlet obstruction are critical determinants of both potential benefit and risk following TURP in men with NLUTD. TURP should therefore be considered selectively and guided by objective urodynamic findings.