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Concomitant surgery for benign prostatic enlargement and bladder stones reduces recurrence odds to 0.18Combined surgery for prostate growth and bladder stones improves outcomes

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Key Takeaway
Consider concomitant surgery for BPE and bladder stones to reduce stone recurrence and improve urinary symptoms.

This meta-analysis evaluated outcomes for men with benign prostatic enlargement (BPE) and concurrent bladder stones (BS). The analysis included over 500 patients to compare concomitant BPE/BS surgery against treatment of bladder stones alone. The study focused on perioperative and postoperative outcomes, including stone recurrence, urinary symptoms, and complication rates.

The synthesis indicates that the concomitant surgery group had significantly lower odds of bladder stone recurrence (OR 0.18; 95% CI 0.10-0.33, p < 0.00001) and better urinary symptoms at last follow-up (-3.09 points mean difference, p < 0.00001). However, minor complications (Clavien 1-2) were more frequent in the concomitant surgery group (OR 4.35, p < 0.0001). Stone-free rates did not differ significantly between groups.

A noted limitation is that the comparison for major complications was likely underpowered, and the included studies contained varying levels of risk of bias. Clinically, concurrent treatment appears to offer significant benefits in recurrence prevention and symptom management without a statistically significant increase in major perioperative risks.

How this fits prior evidence

This meta-analysis addresses a gap by providing evidence on the surgical management of comorbid conditions. It complements existing evidence regarding bladder stone risk stratification in BPH patients by offering specific outcome data for concurrent surgery. The finding that concomitant surgery reduces recurrence odds to 0.18 and improves urinary symptoms provides a basis for managing these co-occurring conditions.

Men with both an enlarged prostate and bladder stones often face a difficult choice about how to manage their symptoms. New data from over 500 patients suggests that treating both conditions during one surgery may offer better long-term results than treating just the stones alone.

The analysis found that men who had concurrent surgery for both issues saw much lower odds of their bladder stones coming back. These same men also reported better urinary symptoms at their final follow-up compared to those who only had their stones treated. While this combined approach led to more frequent minor complications, there was no significant difference in the number of major complications between the two groups.

It is important to note that while the results are promising for reducing stone recurrence and improving daily comfort, the data comes from a small number of studies with varying levels of risk. Because the comparison for major complications involved a limited amount of data, the full safety profile may not be fully clear yet.

What this means for you:
Treating prostate growth and bladder stones together reduces stone recurrence and improves urinary symptoms.

Common questions

Does treating both conditions at once reduce the chance of stones coming back?

Yes, the data shows that men who had surgery for both an enlarged prostate and bladder stones had significantly lower odds of their stones returning. The study found a very low odds ratio of 0.18 for recurrence in the group that received combined treatment.

Are there more risks with the combined surgery?

The combined approach led to more frequent minor complications, such as those classified as Clavien 1-2. However, there was no significant difference in major complications between those who had only bladder stone treatment and those who had both conditions treated at once.

Will the surgery improve my daily urinary symptoms?

Men who underwent surgery for both an enlarged prostate and bladder stones reported better urinary symptoms at their final follow-up. These patients saw a mean difference of 3.09 points in their symptom scores compared to those treated only for stones.

Study Details

Study typeMeta analysis
Sample sizen = 500
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
PURPOSE: Men with benign prostatic enlargement (BPE) frequently present with concomitant bladder stones (BS), yet the optimal surgical strategy remains debated. This systematic review and meta-analysis aimed to compare perioperative and postoperative outcomes of concomitant BPE/BS surgery against BS treatment alone. METHODS: Following the 2020 PRISMA framework, a comprehensive search was conducted on 9 March 2026. Binary outcomes were pooled using the Cochran-Mantel-Haenszel method and reported as odds ratios (OR) with 95% confidence intervals (CI). Continuous outcomes were assessed using inverse variance with 95% CI. Risk of bias was assessed with RoB 2 and ROBINS-I. RESULTS: Seven comparative studies involving over 500 patients were included. Quality assessment revealed some concerns in the overall risk of bias for the single randomized trial, while non-randomized studies showed moderate (3 studies) and high overall risk of bias (3 studies). Concomitant surgery was associated with a significantly lower odds of BS recurrence (OR 0.18, 95% CI 0.10-0.33, p < 0.00001) and better urinary symptoms at last follow-up (mean IPSS difference - 3.09 points, p < 0.00001) compared with BS surgery alone. Minor complications (Clavien 1-2) were more frequent in the concomitant surgery group (OR 4.35, p < 0.0001), while major complications and stone-free rates did not differ significantly, though the comparison was likely underpowered for major complications. The rate of subsequent BPE surgical procedure in patients who had BS surgery alone ranged from 10% to 41%. CONCLUSION: Concomitant BPE and BS surgery substantially reduces stone recurrence and improves lower urinary tract symptoms without meaningfully increasing serious perioperative risk, supporting its adoption in selected cases when BS is related to BPE with bladder outlet obstruction.
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