Should prostatectomy be performed in patients with bladder calculi concomitant benign prostatic obstruction who have not received medical treatment?

Background: The historical dogma that bladder calculi comprise the main indication for prostatic surgery has recently been questioned. In this study, we aimed to predict which patients should undergo simultaneous prostate and bladder calculi surgery or only bladder calculi removal by evaluating preoperative risk factors. Methods: : One-hundred seventeen men with bladder stones and concomitant benign prostatic obstruction (BPO) who had not received medical treatment before were included in the study. In the first step, only the bladder calculi of the patients were removed and medical treatment for BPO was given. The patients who benefited from medical treatment during the follow-up were defined as Group 1, and the patients who required prostate surgery for any indication were Group 2. Risk factors for prostate surgery requirements were determined by comparing preoperative characteristics between the two groups with a logistic regression model. Results: : In the follow-up of 117 patients with bladder stones removed and medical treatment initiated, 49 (41.9%) patients were found to have prostate surgery indications. The indication in 33 of 49 (67.3%) patients was medical treatment failure. Presence of intravesical prostatic protrusion (IPP) and post-voiding high residual urine volume was found to be preoperative risk factor for the requirement of future prostate surgery (Odds ratio: 2.071, 95% CI: 1.05-4.05, P=0.034, odds ratio:1.013, 95% CI:1.007-1.019, P <0.001). Conclusion: In patients who have not received medical treatment for BPO before, bladder calculi developing secondary to BPO do not always constitute an indication for prostate surgery.