Overactive bladder (OAB) symptoms are prevalent in patients with bladder outlet obstruction (BOO). Although the pathogenesis of OAB in men with BOO is still under investigation, OAB symptoms might persist following an outflow surgery. It is, thus, crucial to prognosticate preoperatively the outcome of a deobstructive operation. This review aims to systematically investigate the preoperative factors that could prognosticate the persistence of OAB symptoms following deobstruction surgery in males.
This is a systematic review of the current literature according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Randomised controlled trials and observational studies of both prospective and retrospective design were considered eligible for the analysis. The Quality in Prognosis Studies tool was used for assessing the risk of bias.
Thirty studies, involving 8043 patients who had persistent storage symptoms following surgical BOO relief, were included. Across adjusted analyses, older age and a higher baseline storage symptom burden were the most frequently associated factors, though findings were inconsistent. Urodynamic measures such as detrusor overactivity, bladder capacity, and detrusor contractility showed heterogeneous results, with some positive and some protective signals. Other factors (eg, prostate volume, prostate-specific antigen, maximum flow rate, postvoid residual, and comorbidities) were uniformly null. Overall certainty of evidence was very low, reflecting inconsistency, imprecision, and reliance on single-study signals.
Current evidence is of limited quality; no preoperative factor demonstrated robust prognostic value. Older age and a greater storage symptom burden may be associated with persistence in some adjusted models, whilst urodynamic prognostic factors remain uncertain.
European urology focus. 2025 Dec 16 [Epub ahead of print]
Ioannis Loufopoulos, Efstathios Papaefstathiou, Jean-Nicolas Cornu, Christian Gratzke, Apostolos Apostolidis
Department of Urology, Ipswich General Hospital, Ipswich, UK., Urology Department, Russell's Hall Hospital DGFT, Dudley, UK., Department of Urology, Charles Nicolle Hospital, Rouen, and University of Rouen, France., Department Chirurgie, Klinik für Urologie, University of Freiburg, Freiburg, Germany., 2nd Department of Urology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece. Electronic address: .