To evaluate the progression of lower urinary tract symptoms (LUTS) after deobstructive surgery and to identify predictors of persistent symptoms at six months in men with benign prostatic obstruction (BPO), with emphasis on the role of detrusor overactivity (DO).

This was a prospective longitudinal observational study based on a systematically collected database of patients with LUTS secondary to BPO. All patients who agreed to participate and signed the informed consent form were included. First, they underwent a preoperative urodynamic study (UDS) and were stratified according to the presence of detrusor overactivity. Patients were treated with transurethral resection of the prostate or open prostatectomy. Symptom severity was assessed using the International Prostate Symptom Score (IPSS) preoperatively and at six months postoperatively. Symptom progression was analyzed, and predictors of persistent LUTS at six months were evaluated.

A total of 161 men were included, of whom 69 had DO and 92 did not. The average age was 69.56 (±7.99) in the DO group and 67.56 (±8.06) in the non-DO group. The BMI was 26 in both groups. Patients with DO presented greater bladder outlet obstruction (bladder outlet obstruction index: 74.77 vs. 53.44; p < 0.01) and larger prostate volumes (84.26 g vs. 62.77 g; p < 0.01). Preoperatively, patients with DO had higher IPSS total and storage subscores (p < 0.01). Postoperatively, storage symptoms remained significantly higher in the DO group up to three months (p < 0.05), but no significant differences were observed between groups at six months. Overall, 80.12% (n = 129) of patients experienced resolution of symptoms, while 19.88% (n = 32) had persistent LUTS at six months. Higher body mass index (BMI), prior urinary incontinence, and higher IPSS scores at three months were significantly associated with persistent symptoms (p < 0.01) (Table1). Age was not a significant predictor.

Although patients with DO present more severe baseline symptoms and delayed early improvement, surgical outcomes at six months are comparable to those without DO. Persistent symptoms appear to be more strongly associated with clinical factors and early postoperative evolution than with preoperative DO itself.

Detrusor overactivity does not negatively impact long-term symptom resolution after deobstructive surgery. However, BMI, prior urinary incontinence, and early postoperative symptom persistence are important predictors of unfavorable outcomes and may guide individualized follow-up strategies.