Is Treating Bladder Outlet Really Needed when Removing Bladder Stones: Outcomes of Bladder Stones Removal Without Concomitant BPO Surgery

<b><i>Introduction:</i></b> 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. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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. <b><i>Conclusion:</i></b> 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.