Changes in Bladder Outlet Obstruction After Photoselective Vaporization of the Prostate in Men With and Without Detrusor Underactivity: A Retrospective Propensity Score‐Matched Study

ABSTRACT Objectives To compare symptomatic improvement after photoselective vaporization of the prostate (PVP) between patients with and without detrusor underactivity (DU), together with objective changes in urodynamic parameters assessed by pressure‐flow study (PFS). Methods This single‐center retrospective study evaluated 136 benign prostatic hyperplasia (BPH) patients treated with a 180 W PVP‐XPS system from 2020 through 2025. The patients were divided into DU and non‐DU groups based on the bladder contractility index (BCI), with DU defined as BCI < 100. We retrospectively analyzed selected patients with BPH and clinically or urodynamically relevant bladder outlet obstruction (BOO) who underwent PVP and completed PFS before and 6 months after surgery. Propensity score matching (PSM) was applied to adjust for age and the baseline BOO index (BOOI). Results A total of 105 patients were included in the final analysis and 53 were in the DU group. The DU group had a significantly lower BOOI (48.6 ± 17.5 vs. 71.4 ± 32.3, p < 0.01) than the non‐DU group. After PSM, age and baseline BOOI were well balanced, but BCI remained significantly different. No significant differences between the two groups were observed in questionnaire scores or uroflowmetry findings at 6 months after surgery. The BOOI at 6 months after surgery was not significantly different between the DU group (13.4 ± 13.7) and the non‐DU group (13.7 ± 19.3) ( p = 0.93). BOOI reduction was also not significantly different between the DU group (−37.0 ± 24.1) and the non‐DU group (−36.2 ± 24.5) ( p = 0.90). Conclusion In selected patients with clinically or urodynamically relevant BOO, significant improvements in BOOI and LUTS were observed in patients with DU after PVP, with no statistically significant between‐group differences detected at 6 months.