Detrusor underactivity (DUA), defined as reduced strength and/or duration of bladder contraction resulting in incomplete bladder emptying, may coexist in up to one-third of men with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms. Among patients undergoing BPH surgery, DUA has been considered a predictor of poor outcomes, as impaired detrusor function may limit postoperative voiding recovery. However, existing evidence is conflicting. We aimed to evaluate perioperative outcomes in men with DUA compared with those with normal contractility (NC) following surgical management of BPH.
We systematically searched PubMed, Embase and Scopus databases for studies comparing BPH surgical outcomes in men with DUA and NC. Subgroup analyses were performed by procedure type (holmium laser enucleation of the prostate [HoLEP], photoselective vaporization of the prostate [PVP], and transurethral resection of the prostate [TURP]). Outcomes of interest included acute urinary retention (AUR), major complications, operative time, length of stay, and changes in International Prostate Symptom Score (IPSS), postvoid residual volume (PVR) and peak urinary flow rate (Qmax). Random- or fixed-effects models were used based on heterogeneity. Results were reported with mean differences (MD) or odds ratios (OR) with 95% confidence intervals.
Twelve non-randomized studies, totaling 2,773 patients (1,238 DUA; 1,535 NC) were analyzed. HoLEP was the predominant procedure followed by PVP. No significant between-group differences were observed in AUR (OR 1.12, 95% CI: 0.62-2.04), major complications (OR 1.24, 95% CI: 0.35-4.34), operative time (MD -8.28 min, 95% CI: -16.66, 0.10), or length of stay (MD 0.01 days, 95% CI: -0.10, 0.12). Six-month follow-up data were available only for HoLEP. While IPSS change favored the NC group (MD -1.58, 95% CI: -2.03, -1.14), no significant differences were observed in PVR or Qmax. One-year IPSS change across TURP and PVP showed no significant differences.
Surgical treatment of BPH in men with concomitant DUA appears to be non-inferior to those with NC, providing similar short-term functional outcomes without increasing perioperative morbidity. Prospective studies with longer follow-up are needed to determine long-term efficacy.
None
