Symptomatic benefit and urodynamic obstruction relief represent relevant outcomes of therapies for lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). We summarized evidence from studies concurrently assessing variations in terms of symptoms severity and invasive urodynamic measures of obstruction following medical and surgical therapies for LUTS/BPH.
We performed a systematic review of PubMed, Scopus, and Web of Science in June 2023.
We identified 29 publications: 14 (872 patients) and 15 (851 patients) studies addressing medical and surgical therapies, respectively. The mean percentage total International Prostate Symptom Score (IPSS) improvements ranged from -2.5% to 56.3% and from 35.1% to 82.1% following medical and surgical therapies, respectively. The corresponding mean percentage Bladder Outlet Obstruction Index (BOOI) improvements ranged from 7.8% to 53.5% and from 22.4% to 138.6%, respectively. Holmium laser enucleation of the prostate (HoLEP) provided IPSS improvements in the higher range and the greatest BOOI reduction.
Globally, based on available evidence, more pronounced symptomatic benefits are observed following treatments providing greater deobstructive effect. In detail, patients undergoing surgery exhibit greater IPSS and BOOI improvements than those receiving medical therapy.
Treatments for lower urinary tract symptoms suggestive of benign prostatic hyperplasia providing greater urodynamic improvements also provide greater symptomatic benefit. Surgical procedures provide greater symptomatic and urodynamic outcomes than medical therapies. Maximal obstruction relief, together with symptomatic benefits in the higher ranges, is observed following holmium laser enucleation of the prostate.
European urology. 2024 May 14 [Epub ahead of print]
Massimiliano Creta, Giorgio I Russo, Naeem Bhojani, Marcus J Drake, Christian Gratzke, Benoit Peyronnet, Claus Roehrborn, Kari A O Tikkinen, Jean-Nicolas Cornu, Ferdinando Fusco
Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy. Electronic address: ., Urology Section, Department of Surgery, University of Catania, Catania, Italy., Division of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada., Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK., Department of Urology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany., Department of Urology, Rennes Academic Hospital, University of Rennes, Rennes, France., Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA., Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Surgery, South Karelian Central Hospital, Lappeenranta, Finland; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada., Charles Nicolle University Hospital, Rouen Cedex, France., Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy.