Detrusor underactivity (DUA) may coexist in up to one-third of men with benign prostatic hyperplasia (BPH) and is traditionally associated with poorer surgical outcomes, as impaired contractility may limit postoperative voiding recovery. Existing evidence, however, remains conflicting. We aimed to compare perioperative and functional outcomes in men with DUA and those with normal contractility (NC) following BPH surgery.
A systematic review and meta-analysis were conducted adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, and Scopus were systematically searched for comparative studies. Subgroup analyses were performed according to procedure type. Outcomes included perioperative events and changes in functional parameters.
Fourteen studies including 4,345 patients (2060 DUA and 2,285 NC) were analyzed. HoLEP was the most common procedure, followed by TURP. Postoperative urinary retention (OR 1.63, 95% CI 1.21-2.20) and minor complications (OR 1.31, 95% CI 1.08-1.59) were more frequent in the DUA group, while major complication rates were similar (OR 1.46, 95% CI 0.81-2.65). At 6 months, changes in Qmax and PVR were comparable between groups. Reduction in IPSS favored NC patients at 6 months but was no longer observed at 1 year.
BPH surgery appears to be safe and effective in men with concomitant DUA. Although postoperative urinary retention and minor complications were more frequent in patients with DUA, major complications and functional outcomes were similar, particularly beyond the early postoperative period. Given that most available data are retrospective and definitions of DUA remain heterogeneous, further randomized studies employing a standardized DUA definition are needed.
International urology and nephrology. 2026 May 11 [Epub ahead of print]
Alejandro Calvillo-Ramirez, Luis A Esparza-Miranda, Ana Paulina Casas-Huesca, Hector R Gutierrez, David E Hinojosa-Gonzalez, Mahmoud Khalil, Abhinav Sidana
Section of Urology, Department of Surgery, University of Chicago, 5815 S. Maryland Ave, Chicago, IL, 60637, USA. ., Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Facultad de Medicina, Universidad Autonoma de Guadalajara, Guadalajara, Jalisco, Mexico., Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA., Section of Urology, Department of Surgery, University of Chicago, 5815 S. Maryland Ave, Chicago, IL, 60637, USA.