Overactive bladder following surgical intervention for benign prostatic hyperplasia: treatment outcomes in routine clinical practice

Introduction. Various surgical methods for the treatment of benign prostatic hyperplasia (BPH) effectively alleviate voiding symptoms and improve urinary flow quality. However, patient satisfaction often decreases due to the persistence of storage symptoms following surgical intervention.

Objective. To determine the prevalence of persistent storage symptoms and overactive bladder (OAB), optimal approaches to the treatment of symptoms after surgical treatment of BPH in clinical practice.

Materials & methods. The study included 94 patients aged 53 – 79 years who underwent surgery for BPH, with persistent storage symptoms in 1 – 3 months after surgery (IPSS-storage score ≥ 3). The patients underwent urodynamic examination. In the case of persistent symptoms without confirmed OAB, behavioral therapy was performed (group 1). In case of detrusor overactivity («dry» OAB), patients were prescribed medication solifenacin 5 mg daily (group 2), in case of terminal detrusor overactivity, urgent urinary incontinence («wet» OAB), combination therapy solifenacin 5 mg + mirabegron 50 mg (group 3) was prescribed.

Results. Patient characteristics in the preoperative period showed no statistically significant differences between groups regarding age, urodynamic parameters, and lower urinary tract symptoms (LUTS) as assessed by the IPSS questionnaire. At the initiation of therapy, the median storage symptom scores were 4, 8, and 9 points in groups 1, 2, and 3, respectively. Both the behavioral and pharmacological therapy groups demonstrated a statistically significant reduction in the severity of storage symptoms over time (p < 0.001). After 12 weeks, the median storage symptom scores were 3 points in group 1, 4 points in group 2, and 6 points in group 3. Urgent incontinence was eliminated in group 3 after treatment. By 12 months after surgical treatment and drug therapy, the irritative symptoms and the number of nocturia episodes approach equal values in all groups (p > 0.05). Patients from the drug therapy groups showed high adherence to therapy, among them there were no significant side effects requiring discontinuation of therapy.

Conclusion. The use of pharmacological therapy with M-cholinergic antagonists and/or β3-adrenoceptor agonists in the postoperative period in patients with confirmed detrusor overactivity contributes to a reduction in urgency symptoms and enhances patient treatment satisfaction. In the absence of detrusor overactivity or with an IPSS storage score ≤ 6, behavioral therapy represents a viable alternative to pharmacological treatment.

1. Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. J Urol. 1984;132(3):474-479. DOI: 10.1016/s0022-5347(17)49698-4

2. Wang YB, Yan SY, Xu XF, Huang X, Luo LS, Deng YQ, Li XH, Huang Q, Wang YY, Huang J, Jin YH, Zeng XT. Comparison on the Efficacy and Safety of Different Surgical Treatments for Benign Prostatic Hyperplasia With Volume >60 mL: A Systematic Review and Bayesian Network Meta-Analysis of Randomized Controlled Trials. Am J Mens Health. 2021;15(6):15579883211067086. DOI: 10.1177/15579883211067086

3. Chen F, Chen Y, Zou Y, Wang Y, Wu X, Chen M. Comparison of holmium laser enucleation and transurethral resection of prostate in benign prostatic hyperplasia: a systematic review and meta-analysis. J Int Med Res. 2023;51(8):3000605231190763. DOI: 10.1177/03000605231190763

4. Liao CH, Chung SD, Kuo HC. Diagnostic value of International Prostate Symptom Score voiding-to-storage subscore ratio in male lower urinary tract symptoms. Int J Clin Pract. 2011;65(5):552-558. DOI: 10.1111/j.1742-1241.2011.02638.x

5. Kotov S.V., Perov R.A., Zhestkov I.A., Novikov A.A., Nemenov A.A. Holmium laser enucleation for large prostate hyperplasia: assessment of functional outcomes and postoperative complications. Urology Herald. 2024;12(2):33-42. (In Russian). DOI: 10.21886/2308-6424-2024-12-2-33-42

6. Panferov A.S., Kotov S.V., Yusufov A.G., Elagin V.V., Bekreev E.A., Badakva G.V., Semenov A.P. Laparoscopic transvesical adenomectomy for large and giant prostate gland. Experimental and Clinical Urology. 2022;15(1):102-110. (In Russian). DOI: 10.29188/2222-8543-2022-15-1-102-110

7. Castellani D, Di Rosa M, Saredi G, Pacchetti A, Banchero R, Ambrosini F, Meroni P, Guano G, Boltri M, Bucci S, Simonetti E, Maestroni UV, Ferretti S, Terrone C, Dellabella M. Change in Postoperative Storage Symptoms and De Novo Urge Incontinence After Thulium:YAG Laser Enucleation of the Prostate: Results from a Prospective Multicenter Study. J Endourol. 2022;36(9):1223-1230. DOI: 10.1089/end.2022.0118

8. Kim SJ, Park SG, Pak S, Kwon O, Lee YG, Cho ST. Predictive factors for postoperative medication therapy for overactive bladder symptoms after holmium laser enucleation of prostate. Int J Urol. 2023;30(11):1036-1043. DOI: 10.1111/iju.15260

9. Jeong J, Lee HS, Cho WJ, Jung W, You HW, Kim TH, Sung HH, Lee KS. Effect of Detrusor Overactivity on Functional Outcomes After Holmium Laser Enucleation of the Prostate in Patients With Benign Prostatic Obstruction. Urology. 2015;86(1):133-138. DOI: 10.1016/j.urology.2015.03.033

10. Volkov S.N., Pushkar D.Yu., Kolontarev K.B., Stepanchenko V.S., Tereshchenko V.I., Dzharimok A.R., Shevyakina A.E., Daurov M.A. The severity of lower urinary tract symptoms during the postoperative period as a factor in choosing an approach to surgical treatment for large prostate hyperplasia: holmium enucleation of the prostate (HoLEP) vs laparoscopic simple prostatectomy. Urology Herald. 2024;12(2):5-14. (In Russian). DOI: 10.21886/2308-6424-2024-12-2-5-14

11. Martov A.G., Turin D.E., Ergakov D.V., Andronov A.S., Kamalov A.A. Selection of drug therapy in patients after bipolar transurethral resection of the prostate depending on its original size. Experimental and Сlinical Urology. 2019;11(2):70-79. (In Russian). DOI: 10.29188/2222-8543-2019-11-2-70-78