Clinical Scorecard: Concurrent Surgical Management of Bladder Calculi and Benign Prostatic Obstruction: A Comprehensive Review from EAU Endourology Challenging Conventional Practices

At a Glance

Key Highlights

• Bladder stones and BPO frequently coexist but their pathophysiological link is complex and not solely mechanical obstruction.
• Simultaneous outlet surgery with stone removal is common but its universal necessity is questioned due to heterogeneous evidence.
• Stone clearance rates are high regardless of surgical strategy, but variability exists in recurrence, functional outcomes, and complications.

Guideline-Based Recommendations

Diagnosis

• Evaluate bladder stones and BPO with clinical, imaging, and symptom assessment.
• Consider prostate size and post-void residual volume as risk indicators, acknowledging their limitations.
• Use urodynamic assessment selectively to clarify functional obstruction.

Management

• Simultaneous outlet surgery plus stone removal is often performed but staged management with postoperative reassessment is a valid alternative.
• Medical therapy for BPO may be used adjunctively or as initial management.
• Minimally invasive surgical therapies remain exploratory and are not yet established for this indication.

Monitoring & Follow-up

• Monitor stone recurrence rates and symptom scores (IPSS, Qmax, post-void residual urine).
• Assess perioperative and postoperative complications using standardized classifications (e.g., Clavien–Dindo).
• Evaluate functional outcomes including continence, ejaculatory function, and quality of life.

Risks

• Potential for selection bias and confounding in existing studies.
• Unclear impact of simultaneous surgery on sexual dysfunction and continence.
• Variability in complication profiles depending on surgical approach.

Patient & Prescribing Data

Adult men with concomitant bladder stones and BPO undergoing surgical or medical management

High stone clearance achieved with both combined and isolated stone surgery; individualized treatment decisions recommended considering functional outcomes and patient preferences.

Clinical Best Practices

• Adopt a patient-centered approach considering continence, ejaculatory function, and quality of life in treatment planning.
• Use standardized symptom and functional outcome measures to guide management and follow-up.
• Consider staged management with postoperative reassessment rather than routine simultaneous outlet surgery.
• Apply risk stratification cautiously given limitations of prostate size and post-void residual volume as predictors.
• Remain cautious about minimally invasive therapies until further evidence establishes their role.

References

• EAU Guidelines on Benign Prostatic Obstruction
• PRISMA-ScR Reporting Guidelines
• Risk of Bias Tools (RoB 2 and ROBINS-I)