Persistence of Nocturia after BPH Surgery: A Multicenter Study

Nocturia is often regarded as one of the most persistent and burdensome lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). Despite being a primary driver for surgical intervention, its postoperative trajectory remains poorly defined. Our multicenter study aimed to provide a focused evaluation of nocturia outcomes following endoscopic enucleation of the prostate (EEP), using a novel response classification system called NECIST, inspired by the RECIST oncologic framework.

Among 120 patients undergoing EEP, we observed that more than one-third continued to experience bothersome nocturia after surgery, with only 45% achieving complete remission and 19% reporting partial improvement. These findings highlight the complex, multifactorial pathophysiology of nocturia, which often extends beyond bladder outlet obstruction (BOO).

Our analysis identified the presence of predominant overactive bladder (OAB) symptoms as the only independent predictor of poor nocturia resolution. Interestingly, traditional variables such as age, prostate size, and comorbidities like diabetes or cardiovascular disease were not significantly associated with postoperative persistence. This underscores the need to consider bladder-centric or systemic etiologies during preoperative assessment and counseling.

A key contribution of our work is the implementation of NECIST criteria, which allow for a more granular and clinically meaningful categorization of nocturia response beyond simplistic binary endpoints. This framework may help guide future research and standardize outcome reporting in nocturia-focused studies.

Ultimately, our findings suggest that while EEP remains an effective treatment for LUTS/BPH, its impact on nocturia is variable. Careful patient selection and tailored counseling are essential, particularly in individuals with preexisting OAB symptoms. As nocturia continues to affect quality of life in many patients postoperatively, multidisciplinary approaches integrating behavioral, pharmacological, and sleep-related strategies should be explored in this population.

Written by: Thibaut Long Depaquit, MD, Department of Urology, Hôpital d'Instruction des Armées Sainte-Anne, Toulon, France; Department of Urology, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France; Department of Urology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.

Read the Abstract

Login