Resident Physician Cedars-Sinai Medical Center, Department of Surgery, Division of Urology
Introduction: The presence of bladder calculi in men with benign prostatic hyperplasia (BPH) or bladder outlet obstruction (BOO) is an indication for BPH/BOO surgery. However, it is unknown how often cystolitholapaxy is done with or without concurrent BPH/BOO treatment. Similarly, reasons for and outcomes of immediate versus deferred BPH/BOO surgery are unknown. Methods: We retrospectively reviewed medical records of men who underwent cystolitholapaxy at our tertiary care center from 2009-2020. Men aged = 40 with at least 2 years of follow-up were included. Those with neurogenic bladder, non-native bladder, or bladder calculi due to foreign bodies or tumors were excluded. Bivariate analysis was used to compare features of men undergoing immediate BPH/BOO surgery (defined as concurrent or within 6 months of cystolitholapaxy) with those for whom surgery was deferred. We ascertained the reason for deferral by reviewing medical notes. Kaplan-Meier analysis was used to compare recurrence of bladder stones and need for subsequent BPH/BOO surgery in the two groups. Results: Our analytic sample included 160 men, of whom 55 (35%) and 105 (65%) had immediate and deferred BPH/BOO surgery, respectively. Median follow-up was 4.5 years in the immediate group and 6.2 years in the deferred group (p=0.01). The most common reason for deferral was patient preference (20% of men who deferred). Men who had immediate surgery were more likely to be older (p=0.001), take BPH medication (p=0.022), and present with urinary retention (p=0.003). No difference in comorbidities was observed. Forty men (38%) who deferred surgery developed recurrent bladder stones compared to 8 (15%) who had immediate surgery (p=0.003) (Figure); 34 men (37%) who deferred surgery had repeat cystolitholapaxy, compared to 5 (9%) who had immediate surgery (p < 0.001). Men with deferred treatment frequently required BPH/BOO-related procedures after cystolitholapaxy (27% at 10 years). Conclusions: Men who deferred BPH/BOO surgery at the time of cystolitholapaxy had a higher risk of recurrent bladder stones and often required subsequent BPH/BOO-related procedures compared with those who underwent immediate BPH/BOO surgery. Men undergoing cystolitholapaxy should consider these risks when deciding whether to pursue concurrent BPH/BOO surgery. SOURCE OF Funding: None
