Delayed surgical treatment of benign prostatic hyperplasia (BPH) can be appropriate for select patients with a first episode of bladder stones and mild-to-moderate lower urinary tract symptoms (LUTS), preliminary research suggests.
Immediate prostatic surgery has been the traditional course of treatment for men with bladder stones and BPH, purportedly to relieve bladder outlet obstruction. The efficacy of newer medications, including alpha blockers, 5-alpha reductase inhibitors, and combination therapies, however, has called into question the routine use of surgery.
Investigators led by Hidefumi Kinoshita, MD, of Kansai Medical University’s Hirakata Hospital in Japan, analyzed outcomes among 34 patients from the hospital who underwent endoscopic bladder stone removal then opted for conservative management of BPH (i.e., watchful waiting or medical therapy with an alpha blocker with or without dutasteride). They noted BPH complications after stone removal and compared International Prostate Symptom Scores, quality of life scores, and post-void residual urine volume before and after treatment.
No BPH-related complications occurred in 76.5% of the patients who opted for conservative management during the 52.6 months of follow up, according to results published online ahead of print in Urology. Following stone removal, average prostate symptom scores also declined from 13.5 to 9.7.
“Although there is still a risk of surgery with conservative management, this approach offers an alternative therapy for patients who refuse immediate prostatic surgery or have significant comorbidities,” the investigators stated.
They stressed that these were select patients with mild-to-moderate LUTS and relatively low post-void residual urine volume.
Among patients experiencing complications, 6 developed recurrent bladder stones, 2 had urinary retention, and 1 had recurrent urinary infections. BPH-related complication-free survival rates were 97% at 1 year, 81.8% at 3 years, and 70.5% at 5 years. Six patients later had an invasive intervention for BPH, such as transurethral resection of the prostate or catheterization. Unlike previous studies, the researchers found prostate volume was the only preoperative factor associated with BPH complications.
It remains important to better understand the natural history of patients who have had bladder stones removed and to identify factors indicating immediate prostatic surgery, the investigators noted. They recommend prospective, randomized trials with large cohorts and longer follow-up.
- Yoshida, T; Kinoshita, H; Nakamoto, T; et al. Published online by Urology, July 30, 2015; doi: 10.1016/j.urology.2015.04.022.