Efficacy and Safety of Endourological Surgery for Managing Overactive Bladder Symptoms in Benign Prostatic Hyperplasia: A Systematic Review and Meta-Analysis

Purpose To systematically review the outcomes of endoscopic surgery in men with benign prostatic hyperplasia (BPH) associated with preoperative overactive bladder (OAB) symptoms. Methods Literature search was conducted on 12th May 2025 including PubMed, MEDLINE, Embase, and Scopus database. Complication rates were assessed using the Cochran-Mantel-Haenszel Method with the random effect model and reported as odds ratio, 95% confidence interval (CI), and P-values. Analyses were 2-tailed and the significance was set at P<0.05. Continuous variables were pooled using the inverse variance of the mean difference with a random effect, 95% CI, and P-values. Results Thirteen studies were included. Overall, there were 1,436 patients, with 672 in the OAB group and 820 patients in the No OAB group. At 6 months postoperatively, the storage symptoms - International Prostate Symptom Score (IPSS) favored the OAB group (mean difference [MD], 1.06; 95% CI, 0.18–1.95; P=0.02); however, changes at 3 and 6 months demonstrated no significant differences. Total-IPSS remained comparable between groups at 3 and 6 months, whereas at 12 months, the No OAB group exhibited significantly better outcomes (MD, 3.66; 95% CI, 1.87–5.45; P<0.0001). The quality-of-life (QoL) index shows no significant difference at 3 months, though HoLEP (holmium laser enucleation of the prostate) favored the OAB group at 6 months (MD, -0.36; 95% CI, -0.62 to -0.10; P=0.006), while overall changes beyond this period favored the No OAB group (MD, -0.61; 95% CI, -1.18 to -0.05; P=0.03). Urge urinary incontinence and the need for postoperative anticholinergic therapy did not differ significantly between groups at any time. Conclusions This meta-analysis reveals that BPH patients with preoperative OAB experienced persistently higher postoperative storage symptoms despite comparable overall symptom improvement, with a more pronounced QoL enhancement over time. These findings emphasize the need for comprehensive preoperative assessment to guide patient counseling, refine surgical expectations, and improve postoperative management.