To evaluate whether preoperative urodynamic diagnoses are associated with postoperative outcomes following prostate outlet surgery.

This retrospective cohort study included male patients who underwent TURP or GreenLight prostate outlet surgery between 2013 and 2025 at a single tertiary center. Patients with a documented preoperative urodynamic diagnosis and adequate postoperative follow-up were included. Because detailed numeric urodynamic parameters were inconsistently available, patients were categorized according to the documented preoperative diagnosis: bladder outlet obstruction (BOO), BOO with detrusor overactivity (BOO+DO), and a DU-related group combining detrusor underactivity (DU) and BOO+DU. The primary outcome was poor postoperative outcome, defined as inability to void at any follow-up, post-void residual (PVR) ≥200 mL at follow-up, or documented failure/re-intervention. Patient dissatisfaction was assessed as a secondary outcome.

Among 191 prostate surgery records, 100 patients had a documented preoperative urodynamic diagnosis. After excluding those with insufficient outcome data, 79 patients were included in the final analysis. Preoperative diagnoses were BOO in 57 patients, BOO+DO in 11, and DU-related in 11. Preoperative catheter dependence was more common in the DU-related group than in the BOO and BOO+DO groups. Poor postoperative outcome occurred in 5/57 (8.8%) patients with BOO, 4/11 (36.4%) with BOO+DO, and 0/11 (0%) in the DU-related group (p=0.014). Compared with BOO alone, BOO+DO was associated with worse outcomes (p=0.032), whereas the DU-related group was not significantly different. Patient dissatisfaction was infrequent and similar across groups.

Preoperative urodynamic diagnosis may help stratify outcomes after prostate outlet surgery. In this cohort, BOO+DO was associated with less favorable postoperative outcomes compared with BOO alone. This may be particularly relevant in patients with mixed storage and voiding dysfunction. Although DU-related patients were more often catheter-dependent preoperatively, this did not translate into worse postoperative outcomes in this cohort.

Preoperative urodynamic diagnosis appears clinically relevant before prostate outlet surgery, particularly when bladder outlet obstruction is accompanied by detrusor overactivity.