Savin Ziv, Dayan Rahmani Linda, Frangopoulos Eve, Gupta Kavita, Durbhakula Vinay, Gallante Blair, Atallah William M, Gupta Mantu
Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
J Endourol. 2025 Jan;39(1):65-70. doi: 10.1089/end.2024.0682. Epub 2024 Nov 26.
While surgical intervention for benign prostatic obstruction (BPO) is traditionally recommended alongside bladder stone removal in males, recent studies have questioned the necessity of this approach. This study aims to evaluate the long-term outcomes of bladder stone removal without concomitant BPO surgery. We conducted a retrospective analysis of males with BPO who underwent bladder stone removal without concomitant BPO surgery in our institution between 2017 and 2024. Clinical and functional variables were collected, and our primary endpoint during the study period was future BPO surgery (BPO surgery-free survival). Secondary outcomes included BPO-related complications, medical therapy burden, and significant increase in post-void residual (PVR). Kaplan-Meier curves, receiver operating characteristic curves, and Cox regression models were used to analyze the results and identify predictors for future BPO surgery. Our cohort consisted of 63 patients with median follow-up of 34 months. During the study period, 13 patients (22%) underwent BPO surgery. The 1-year, 3-year, and 5-year BPO surgery-free survival rates were 90%, 78%, and 78%, respectively. Prostate volume >100 cc and PVR >93 mL were the most significant predictors of future BPO surgery, increasing the likelihood by nearly fourfold. In the absence of concomitant BPO surgery, 94% of patients managed their BPO with medication, and 57% experienced BPO-related adverse outcomes. Bladder stone removal without concomitant BPO surgery offers a high likelihood of avoiding future BPO surgery in the intermediate-term. However, careful patient selection and management of BPO-related risks are crucial. Prostate volume and PVR should be considered in the shared decision-making process.
虽然传统上建议在男性膀胱结石切除的同时进行良性前列腺梗阻（BPO）的手术干预，但最近的研究对这种方法的必要性提出了质疑。本研究旨在评估不伴有BPO手术的膀胱结石切除的长期结果。我们对2017年至2024年期间在我们机构接受不伴有BPO手术的膀胱结石切除的BPO男性患者进行了回顾性分析。收集了临床和功能变量，研究期间我们的主要终点是未来的BPO手术（无BPO手术生存）。次要结果包括BPO相关并发症、药物治疗负担以及排尿后残余尿量（PVR）的显著增加。使用Kaplan-Meier曲线、受试者工作特征曲线和Cox回归模型分析结果并确定未来BPO手术的预测因素。我们的队列包括63名患者，中位随访时间为34个月。在研究期间，13名患者（22%）接受了BPO手术。1年、3年和5年的无BPO手术生存率分别为90%、78%和78%。前列腺体积>100 cc和PVR>93 mL是未来BPO手术最显著的预测因素，可能性增加近四倍。在没有同时进行BPO手术的情况下，94%的患者通过药物治疗BPO，57%的患者经历了BPO相关的不良后果。不伴有BPO手术的膀胱结石切除在中期有很高的可能性避免未来的BPO手术。然而，仔细的患者选择和BPO相关风险的管理至关重要。在共同决策过程中应考虑前列腺体积和PVR。
