Autonomic Modulation and Symptomatic Efficacy of Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia

<b>Background</b>: Benign Prostatic Hyperplasia (BPH) causes Lower Urinary Tract Symptoms (LUTS), impairing quality of life (QoL). Transurethral Resection of the Prostate (TURP) is the gold-standard surgical treatment for Bladder Outlet Obstruction (BOO), but its effects on Autonomic Nervous System (ANS) function-assessed via Heart Rate Variability (HRV)-remains underexplored. To our knowledge, this is the first study to correlate HRV with specific LUTS domains pre- and post-TURP, establishing HRV as a potential biomarker for BPH management. <b>Methods</b>: In a prospective study, 242 men with BPH underwent TURP (2018-2024). Inclusion required age ≥ 50 years, International Prostate Symptom Score (IPSS) ≥ 8, and BOO evidence. HRV (Standard Deviation of Normal-to-Normal Intervals [SDNN], Low-Frequency/High-Frequency [LF/HF] ratio), IPSS, and QoL were assessed preoperatively and 3 months postoperatively. Paired <i>t</i>-tests, Pearson correlations, and multivariate regression (adjusted for age, Body Mass Index [BMI], prostate volume) were used (<i>p</i> < 0.05). <b>Results</b>: HRV (SDNN) increased from 36.97 ± 22.80 ms to 51.67 ± 27.59 ms (<i>p</i> = 0.032), and LF/HF ratio decreased from 1.63 ± 1.60 to 0.73 ± 0.52 (<i>p</i> = 0.028). IPSS fell from 18.5 ± 6.2 to 8.3 ± 4.1 (<i>p</i> < 0.001), with improved voiding (<i>p</i> = 0.004) and storage (<i>p</i> = 0.002) subscores. QoL improved from 3.5 ± 1.2 to 1.8 ± 0.9 (<i>p</i> = 0.003). HRV correlated inversely with IPSS voiding (r = -0.42, <i>p</i> = 0.012; r = -0.38, <i>p</i> = 0.019 post-TURP) and storage subscores (r = -0.29, <i>p</i> = 0.045). Older patients (≥65 years) and those with larger prostates (≥50 mL) showed greater improvements. <b>Conclusions</b>: TURP enhances LUTS, QoL, and ANS function. HRV's correlation with LUTS suggests its biomarker potential, with possible cardiovascular benefits. Longitudinal studies are needed.