Concurrent Surgical Management of Bladder Stones and BPO: Evidence Review

Overview

This scoping review analyzed 15 studies involving 1,233 men with bladder stones and benign prostatic obstruction (BPO) to evaluate outcomes of simultaneous outlet surgery plus stone removal versus isolated stone management. High stone clearance rates were observed across strategies, but variability existed in recurrence, functional outcomes, and complications, challenging the routine use of combined surgery.

Background

Bladder stones and BPO frequently coexist and have traditionally been considered pathophysiologically linked, leading to the common practice of performing simultaneous outlet surgery during stone removal. However, advances in endoscopic techniques and medical therapies, along with emerging understanding of multifactorial stone formation, have questioned this approach. Clinical decision-making is complicated by heterogeneous evidence, variable patient factors, and the unclear role of minimally invasive therapies. This review aimed to synthesize current evidence comparing combined versus isolated surgical management in this population.

Data Highlights

Key Findings

• Stone clearance rates were consistently high regardless of whether combined outlet surgery was performed.
• Recurrence rates, functional outcomes, and complication profiles varied markedly between studies.
• Evidence supporting routine simultaneous outlet surgery during stone removal is largely indirect and heterogeneous.
• Prostate size and post-void residual volume are proposed risk indicators but may not reliably predict functional obstruction.
• Minimally invasive surgical therapies remain exploratory and are not yet established in this setting.
• Patient-centered outcomes such as continence and ejaculatory function are underreported and inconsistently evaluated.

Clinical Implications

Clinicians should carefully individualize management of bladder stones with BPO, considering that high stone clearance can be achieved without routine simultaneous outlet surgery. Functional assessment and patient preferences regarding continence and sexual function should guide treatment selection. The role of minimally invasive therapies requires further validation before widespread adoption.

Conclusion

The current evidence challenges the conventional practice of routine combined surgery for bladder stones and BPO, highlighting the need for personalized approaches and further high-quality studies to clarify optimal management strategies.

References

1. EAU Endourology Challenging Conventional Practices -- Concurrent Surgical Management of Bladder Calculi and Benign Prostatic Obstruction