Bladder neck angle as an anatomical predictor of conservative treatment failure and the need for surgery in benign...

To determine the predictive value of bladder neck angle (BNA) for trial without catheter (TWOC) following acute urinary retention (AUR) due to benign prostatic obstruction (BPO), and to evaluate its role in predicting response to conservative therapy in patients with lower urinary tract symptoms (LUTS).

Outpatients presenting with bothersome LUTS or acute urinary retention (AUR) due to BPO were included in the cohort. The prostate volume, intravesical prostatic protrusion, BNA, and postvoid residual volume were recorded. In patients with AUR, TWOC was performed after 2 weeks of alpha-blocker therapy; those with LUTS received alpha-blockers and 5-alpha reductase inhibitors for 12 months. Surgery was recommended for patients who experienced failure of conservative treatment. The uroflowmetry and International Prostate Symptom Score (IPSS) changes were assessed from baseline to 12 months after treatment.

Among 66 patients with AUR, 32 (48.5%) experienced TWOC failure. BNA demonstrated strong discriminative ability for predicting TWOC failure (AUC 0.855, 95% CI 0.76-0.94), with an optimal cut-off of 89.94° (sensitivity 75%, specificity 84%), outperforming IPP (AUC 0.794, 95% CI 0.68-0.91). Among 335 non-AUR patients receiving combination therapy, 23 (6.8%) required surgery. BNA predicted treatment failure with an AUC of 0.87 and an optimal cut-off of 75.85° (sensitivity 78%, specificity 87%).

BNA is a promising anatomical predictor of TWOC outcome in AUR and may help identify LUTS patients who are likely to experience greater benefit from conservative therapy. Incorporating BNA into clinical assessment may improve risk stratification and treatment planning in BPO management.