Pathogenesis of lower urinary tract symptoms in benign prostatic hyperplasia

BACKGROUND: Lower urinary tract symptoms (LUTS) in men are most commonly associated with prostate pathology, and voiding symptoms in the presence of an enlarged prostate are a key factor in favor of surgical treatment. However, the etiology of LUTS is multifactorial, and these symptoms are not specific to prostate diseases. One potential etiological factor contributing to LUTS in men is radicular and visceral manifestations of degenerative spinal changes. AIM: To assess the role of degenerative spinal diseases in the pathogenesis of LUTS in patients with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: This study analyzed data from 168 men (mean age 64.1 ± 1.2 years, range 58–83) who underwent surgery for BPH to investigate the potential causes of persistent LUTS postoperatively. In addition to general clinical and urological assessments, all patients underwent an active clinical-neurological examination to identify chronic neurological conditions. RESULTS: Postoperative examination of BPH patients with persistent LUTS revealed neurological pathology in 62.5% of cases, which could independently contribute to urinary dysfunction. In 47.02% of cases, these pathologies were degenerative spinal changes with radicular and autonomic manifestations. The predominant manifestation of LUTS in patients with degenerative spinal changes was overactive bladder, with scores ranging from 8 to 19 points (mean 13.11 ± 0.02) on the Overactive Bladder Questionnaire (OAB-q). Treatment of concomitant neurological pathology led to the resolution or significant alleviation of LUTS and improved quality of life in patients with persistent urinary disorders following BPH surgery. CONCLUSIONS: Persistent irritative LUTS after surgical treatment of BPH may be associated with concomitant degenerative spinal changes with radicular and autonomic manifestations. Targeted treatment of these conditions, primarily in the form of myofascial and radicular syndromes, significantly reduces the severity of LUTS.