Efficacy and Safety of Endourological Surgery for Managing Overactive Bladder Symptoms in Benign Prostatic Hyperplasia: A Systematic Review and Meta-Analysis

Purpose: To systematically review the outcomes of endoscopic surgery in men with benign prostatic hyperplasia (BPH) associated with preoperative overactive bladder (OAB) symptoms.Methods: Literature search was conducted on 12th May 2025 including PubMed, MEDLINE, Embase, and Scopus database. Complication rates were assessed using the Cochran-Mantel-Haenszel Method with the random effect model and reported as odds ratio, 95% confidence interval (CI), and P-values. Analyses were 2-tailed and the significance was set at P<0.05. Continuous variables were pooled using the inverse variance of the mean difference with a random effect, 95% CI, and P-values.Results: Thirteen studies were included. Overall, there were 1,436 patients, with 672 in the OAB group and 820 patients in the No OAB group. At 6 months postoperatively, the storage symptoms - International Prostate Symptom Score (IPSS) favored the OAB group (mean difference [MD], 1.06; 95% CI, 0.18–1.95; P=0.02); however, changes at 3 and 6 months demonstrated no significant differences. Total-IPSS remained comparable between groups at 3 and 6 months, whereas at 12 months, the No OAB group exhibited significantly better outcomes (MD, 3.66; 95% CI, 1.87–5.45; P<0.0001). The quality-of-life (QoL) index shows no significant difference at 3 months, though HoLEP (holmium laser enucleation of the prostate) favored the OAB group at 6 months (MD, -0.36; 95% CI, -0.62 to -0.10; P=0.006), while overall changes beyond this period favored the No OAB group (MD, -0.61; 95% CI, -1.18 to -0.05; P=0.03). Urge urinary incontinence and the need for postoperative anticholinergic therapy did not differ significantly between groups at any time.Conclusions: This meta-analysis reveals that BPH patients with preoperative OAB experienced persistently higher postoperative storage symptoms despite comparable overall symptom improvement, with a more pronounced QoL enhancement over time. These findings emphasize the need for comprehensive preoperative assessment to guide patient counseling, refine surgical expectations, and improve postoperative management.