Prostatic calculi (PC) have been increasingly recognized with the aid of advanced imaging modalities such as transrectal ultrasound (TRUS) and computed tomography. Their presence has been linked to lower urinary tract symptoms (LUTS), erectile dysfunction (ED), chronic prostatitis, and chronic pelvic pain. Intravesical prostatic protrusion (IPP) is another critical factor influencing bladder outlet obstruction. This study aimed to evaluate the association between prostatic stone burden, IPP, and changes in urinary flow parameters before and after anatomical endoscopic enucleation of the prostate (AEEP).

We retrospectively analyzed patients aged 45–95 who underwent AEEP for benign prostatic hyperplasia (BPH) between 2019 and 2020 at a single tertiary center, performed by a single surgeon. Prostatic calculi were assessed using TRUS and categorized into two groups based on whether calculi occupied more or less than 50% of the boundary between peripheral and transitional zones. IPP was also recorded. Voiding volume (VV) and peak flow rate (PFR) were measured before and 1.5 months after surgery. Statistical analysis included paired t-tests and Fisher’s exact test.

Of 245 patients, 175 had detectable prostatic calculi, and 117 had complete pre- and post-operative voiding data. Patients with greater stone burden had significantly lower VV both before and after surgery compared to those with lesser burden (Figure. 1). Postoperative improvement in PFR was significantly greater in patients with fewer calculi. Additionally, higher IPP was associated with less improvement in both VV and PFR (Figure. 2).

The findings suggest that both prostatic calculi and IPP may negatively influence bladder function recovery after AEEP. Prostatic stones may contribute to chronic intraprostatic inflammation or fibrosis, potentially affecting detrusor function or bladder compliance. Meanwhile, prominent IPP may persistently distort bladder outlet anatomy despite enucleation, limiting functional improvement. These anatomical features should be considered during surgical planning and patient counseling.

Prostatic stone burden and IPP are potential predictors of postoperative voiding outcomes following AEEP. Their presence may indicate less favorable recovery in VV and PFR. Incorporating these parameters into preoperative assessment may help optimize individualized treatment strategies for patients with BPH.

Ferrari A, Dantonello TM, Bisogno G, et al. Paratesticular rhabdomyosarcoma: report from the European paediatric soft tissue sarcoma study group. Eur J Cancer. 2011;47(16):2349–2356. doi:10.1016/j.ejca.2011.06.036
Hyun JS. Clinical significance of prostatic calculi: a review. World J Mens Health. 2018;36(1):15–21. doi:10.5534/wjmh.17025
Lee SW, Choe HS. The influence of prostatic calculi on lower urinary tract symptoms and sexual dysfunction: a narrative review. Transl Androl Urol. 2021;10(2):929–938. doi:10.21037/tau-20-1221