Skip to main content

Advertisement

SpringerLink
Log in

Persistent Lower Urinary Tract Symptoms After BPH Surgery

  • REVIEW
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Lower urinary tract symptoms (LUTS) after surgical management for BPH pose a significant clinical challenge for urologists. Despite high success rates in relieving LUTS, there is a subset of patients who experience persistent symptoms after intervention. In this review article, we describe the management of patients with new or persistent LUTS after endoscopic bladder outlet surgery.

Recent Findings

Previously, the goal for BPH management was to remove as much adenomatous tissue as possible. While potentially effective, this may lead to unwanted side effects. There has been a recent paradigm shift for new minimally invasive surgical therapies (MIST) that strategically treat adenomatous tissue, adding potential complexity in managing patients with new or residual symptoms in the postoperative setting.

Summary

There is a paucity of literature to guide optimal workup and care of patients with persistent LUTS after surgical management. We characterize patients into distinct groups, defined by types of symptoms, irritative versus obstructive, and timing of the symptomatology, short term versus long term. By embracing this patient-centered approach with shared decision management, clinicians can optimize outcomes efficiently improving their patients’ quality of life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data Availability

No datasets were generated or analysed during the current study.

Abbreviations

LUTS:

Lower urinary tract symptoms

BPH:

Benign prostatic hyperplasia

BOO:

Bladder outlet obstruction

MIST:

Minimally invasive surgical therapies

TURP:

Transurethral resection of the prostate

OAB:

Overactive bladder

HoLEP:

Holmium laser enucleation of the prostate

SUI:

Stress urinary incontinence

QoL:

Quality of life

PVR:

Postvoid residual

References

Papers of particular interest, published recently, have been highlighted as: •  Of importance •• Of major importance

  1. Launer BM, McVary KT, Ricke WA, Lloyd GL. The rising worldwide impact of benign prostatic hyperplasia. BJU Int. 2021;127(6):722–8. https://doi.org/10.1111/bju.15286.

    Article  PubMed  Google Scholar 

  2. Ibis MA, Cayan S, Tokatli Z, Orhan I, Asci R, Kocamanoglu F, et al. Trends in benign prostatic hyperplasia surgery over the years: a multicenter 14-year retrospective study. Turk J Urol. 2021;47(6):501–8. https://doi.org/10.5152/tud.2021.21262.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Cornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, et al. A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol. 2015;67(6):1066–96. https://doi.org/10.1016/j.eururo.2014.06.017.

    Article  PubMed  Google Scholar 

  4. •• Lerner LB, McVary KT, Barry MJ, Bixler BR, Dahm P, Das AK, et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA GUIDELINE part II-surgical evaluation and treatment. J Urol. 2021;206(4):818–26. https://doi.org/10.1097/JU.0000000000002184. This is the current AUA guidelines for management of BPH symptoms and should be understood by all clinicans treating BPH.

    Article  PubMed  Google Scholar 

  5. •• Gravas S, Gacci M, Gratzke C, Herrmann TRW, Karavitakis M, Kyriazis I, et al. Summary paper on the 2023 European association of urology guidelines on the management of non-neurogenic male lower urinary tract symptoms. Eur Urol. 2023;84(2):207–22. https://doi.org/10.1016/j.eururo.2023.04.008. This is the most recent EUA guidelines for the management of LUTS which is essential for all urologists to review.

    Article  PubMed  Google Scholar 

  6. • Te AE, Cho A, Chughtai BI. How i handle retreatment of LUTS following a failed MIST. Curr Urol Rep. 2021;22(8):40. https://doi.org/10.1007/s11934-021-01054-w. Recent review of the management of LUTS after failed minimally invasive treatments of various technologies for BPH.

    Article  PubMed  Google Scholar 

  7. Kim A, Hak AJ, Choi WS, Paick SH, Kim HG, Park H. Comparison of long-term effect and complications between holmium laser enucleation and transurethral resection of prostate: nations-wide health insurance study. Urology. 2021;154:300–7. https://doi.org/10.1016/j.urology.2021.04.019.

    Article  PubMed  Google Scholar 

  8. Campbell J, Reid J, Ordon M, Welk B. The utilization of benign prostatic hyperplasia and bladder-related medications after a transurethral prostatectomy. Urology. 2019;130:126–31. https://doi.org/10.1016/j.urology.2019.05.003.

    Article  PubMed  Google Scholar 

  9. Chughtai B, Simma-Chiang V, Kaplan SA. Evaluation and management of post-transurethral resection of the prostate lower urinary tract symptoms. Curr Urol Rep. 2014;15(9):434. https://doi.org/10.1007/s11934-014-0434-1.

    Article  PubMed  Google Scholar 

  10. Rieken M, de Nunzio C, Cornu JN, Ramasamy R, Misrai V, Malde S, et al. Medical treatment incidence and persistence after surgical relief of lower urinary tract symptoms suggestive of benign prostatic obstruction: a critical analysis of the literature. Eur Urol Focus. 2023. https://doi.org/10.1016/j.euf.2023.08.013.

    Article  PubMed  Google Scholar 

  11. Mirone V, Imbimbo C, Longo N, Fusco F. The detrusor muscle: an innocent victim of bladder outlet obstruction. Eur Urol. 2007;51(1):57–66. https://doi.org/10.1016/j.eururo.2006.07.050.

    Article  PubMed  Google Scholar 

  12. Bosch R, Abrams P, Averbeck MA, Finazzi Agro E, Gammie A, Marcelissen T, et al. Do functional changes occur in the bladder due to bladder outlet obstruction? - ICI-RS 2018. Neurourol Urodyn. 2019;38(Suppl 5):S56–65. https://doi.org/10.1002/nau.24076.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Han HH, Ko WJ, Yoo TK, Oh TH, Kim DY, Kwon DD, et al. Factors associated with continuing medical therapy after transurethral resection of prostate. Urology. 2014;84(3):675–80. https://doi.org/10.1016/j.urology.2014.04.027.

    Article  PubMed  Google Scholar 

  14. Tsai CH, Fan YH, Lin ATL, Huang WJ. Risk factors for pharmacotherapy for storage symptoms after transurethral resection of the prostate in patients with benign prostatic hyperplasia. Low Urin Tract Symptoms. 2022;14(5):329–33. https://doi.org/10.1111/luts.12438.

    Article  CAS  PubMed  Google Scholar 

  15. Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)–incidence, management, and prevention. Eur Urol. 2006;50(5):969–79. https://doi.org/10.1016/j.eururo.2005.12.042. discussion 80.

    Article  PubMed  Google Scholar 

  16. Singla N, Singla AK. Evaluation and management of lower urinary tract symptoms after outlet surgery for benign prostatic hyperplasia. Curr Bladder Dysfunct Rep. 2016;11(3):242–7. https://doi.org/10.1007/s11884-016-0376-1.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Habib E, Abdallah MF, ElSheemy MS, Badawy MH, Nour HH, Kamal AM, et al. Holmium laser enucleation versus bipolar resection in the management of large-volume benign prostatic hyperplasia: a randomized controlled trial. Int J Urol. 2022;29(2):128–35. https://doi.org/10.1111/iju.14737.

    Article  CAS  PubMed  Google Scholar 

  18. Fenton AS, Morey AF, Aviles R, Garcia CR. Anterior urethral strictures: etiology and characteristics. Urology. 2005;65(6):1055–8. https://doi.org/10.1016/j.urology.2004.12.018.

    Article  PubMed  Google Scholar 

  19. Sekar H, Palaniyandi V, Krishnamoorthy S, Kumaresan N. Post-transurethral resection of prostate urethral strictures: are they often underreported? A single-center retrospective observational cohort study. Urol Ann. 2021;13(4):329–35. https://doi.org/10.4103/UA.UA_165_19.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kuo HC. Analysis of the pathophysiology of lower urinary tract symptoms in patients after prostatectomy. Urol Int. 2002;68(2):99–104. https://doi.org/10.1159/000048427.

    Article  PubMed  Google Scholar 

  21. Wessells H, Morey A, Souter L, Rahimi L, Vanni A. Urethral stricture disease guideline amendment (2023). J Urol. 2023;210(1):64–71. https://doi.org/10.1097/JU.0000000000003482.

    Article  PubMed  Google Scholar 

  22. Elliott SP, Coutinho K, Robertson KJ, D’Anna R, Chevli K, Carrier S, et al. One-year results for the ROBUST III randomized controlled trial evaluating the optilume® drug-coated balloon for anterior urethral strictures. J Urol. 2022;207(4):866–75. https://doi.org/10.1097/JU.0000000000002346.

    Article  PubMed  Google Scholar 

  23. Castellani D, Wroclawski ML, Pirola GM, Gauhar V, Rubilotta E, Chan VW, et al. Bladder neck stenosis after transurethral prostate surgery: a systematic review and meta-analysis. World J Urol. 2021;39(11):4073–83. https://doi.org/10.1007/s00345-021-03718-1.

    Article  PubMed  Google Scholar 

  24. Zhang L, Liu S, Wu K, Mu X, Yang L. Management of highly recurrent bladder neck contractures via transurethral resection combined with intra- and post-operative triamcinolone acetonide injections. World J Urol. 2021;39(2):527–32. https://doi.org/10.1007/s00345-020-03224-w.

    Article  CAS  PubMed  Google Scholar 

  25. Kallidonis P, Spinos T, Peteinaris A, Somani B, Liatsikos E. Salvage holmium laser enucleation of the prostate after previous interventions: a systematic review. BJU Int. 2024;133(2):141–51. https://doi.org/10.1111/bju.16131.

    Article  CAS  PubMed  Google Scholar 

  26. Lomas DJ, Krambeck AE. Long-term efficacy of holmium laser enucleation of the prostate in patients with detrusor underactivity or acontractility. Urology. 2016;97:208–11. https://doi.org/10.1016/j.urology.2016.07.010.

    Article  PubMed  Google Scholar 

  27. Large T, Krambeck AE. Evidence-based outcomes of holmium laser enucleation of the prostate. Curr Opin Urol. 2018;28(3):301–8. https://doi.org/10.1097/MOU.0000000000000498.

    Article  PubMed  Google Scholar 

  28. Sandhu JS, Breyer B, Comiter C, Eastham JA, Gomez C, Kirages DJ, et al. Incontinence after prostate treatment: AUA/SUFU guideline. J Urol. 2019;202(2):369–78. https://doi.org/10.1097/JU.0000000000000314.

    Article  PubMed  Google Scholar 

  29. Elshal AM, Elmansy HM, Elhilali MM. Feasibility of holmium laser enucleation of the prostate (HoLEP) for recurrent/residual benign prostatic hyperplasia (BPH). BJU Int. 2012;110(11Pt C):E845–50. https://doi.org/10.1111/j.1464-410X.2012.11290.x.

    Article  PubMed  Google Scholar 

  30. Abdelaziz A, Bhandari M, Elshabrawy A, Trecarten S, Dalla EE, Samara KA, et al. Contemporary trends of holmium laser enucleation of the prostate (HoLEP) utilization in the United States: a comprehensive analysis using the National Surgical Quality Improvement Program (NSQIP) database (2011–2020). J Endourol. 2024. https://doi.org/10.1089/end.2023.0612.

    Article  PubMed  Google Scholar 

  31. Gauhar V, Lim EJ, Khan TY, Law YXT, Choo ZW, Castellani D, et al. Rezum to the rescue: early outcomes of Rezum on patients with recurrent lower urinary tract symptoms after surgical interventions for benign prostatic enlargement. Andrologia. 2022;54(8):e14450. https://doi.org/10.1111/and.14450.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Indiana University, Indianapolis, IN, USA

    Joshua Heiman

  2. University of Florida, Gainesville, FL, USA

    William M. Snead

  3. Department of Urology, University of Florida, Gainesville, FL, USA

    John Michael DiBianco

Authors
  1. Joshua Heiman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. William M. Snead
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John Michael DiBianco
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

J.H., J.D., and W.S. wrote the manuscript text; J.H. prepared the figure and table.

Corresponding author

Correspondence to Joshua Heiman.

Ethics declarations

Conflict Interests

John Michael DiBianco is a consultant with Boston Scientific.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Heiman, J., Snead, W.M. & DiBianco, J.M. Persistent Lower Urinary Tract Symptoms After BPH Surgery. Curr Urol Rep 25, 125–131 (2024). https://doi.org/10.1007/s11934-024-01202-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-024-01202-y

Keywords

Search

Navigation