Do men with bladder stones benefit from treatment of benign prostatic obstruction (BPO)?

Gianluca Maresca* (Corresponding Author), James Donaldson, Satchi Kuchibhotla Swami, Ismail Mokadem, Sam McClinton

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objective
To identify whether men aged ≥40 years with bladder stones (BS) benefit from treatment of benign prostatic obstruction (BPO).

Patients and methods
A regional, retrospective study of patients undergoing BS surgery between January 2011 and December 2018 was performed using a prospectively collected database. The primary outcome was BS recurrence after successful removal. Kruskal–Wallis and chi-squared statistical tests were used.

Results
A total of 174 patients underwent BS removal and 71 (40.8%) were excluded due to BS formation secondary to causes other than BPO. Hence, 103 men aged ≥40 years had BS successfully removed, of which 40% had a history of upper tract urolithiasis. These men were divided into three groups: those undergoing contemporaneous medical, surgical, or no BPO treatment. Age, diabetes, previous urolithiasis and previous BPO surgery were well matched between the BPO treatment groups. In all, 18 of these men (17%) had BS recurrence after 46 months follow-up.

Recurrences were significantly lower following BPO surgery; one of 34 (3%) men versus five of 28 (18%) with no BPO treatment (P = 0.048) and 12 of 41 (29%) with medical BPO treatment (P = 0.003). Recurrences after medical and no BPO treatment were similar (P = 0.280). In all, 34 men (33%) had BPO complications that were similar between groups (P = 0.378).

Conclusion
This is the largest reported cohort of men, with the longest follow-up after BS removal. Most men aged ≥40 years with BS benefit from BPO surgery. However, the study findings also support a multifactorial aetiology for BS, which questions the dogma that BS are an ‘absolute indication’ for BPO surgery, as is stated in the Non-neurogenic Male Lower Urinary Tract Symptoms European Association of Urology Guideline. Assessment and management of all causative factors is likely to enable selection of which men will benefit from BPO surgery and to reduce BS recurrence rates.
Original languageEnglish
Pages (from-to)619-627
JournalBJU International
Volume130
Issue number5
Early online date17 May 2022
DOIs
Publication statusPublished - Nov 2022

Keywords

  • benign prostatic obstruction
  • benign prostatic hyperplasia
  • bladder stones
  • EAU Guidelines
  • lower urinary tract dysfunction
  • lower urinary tract symptoms
  • metabolic stone formation

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