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Evaluation and management of transient lower urinary tract symptoms (LUTS) after surgery for Benign prostatic obstruction (BPO): a systematic review

Prostate Cancer and Prostatic Diseases (2026)Cite this article

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Abstract

Background

The evaluation and management of lower urinary symptoms (LUTS) experienced in the immediate post-operative period after benign prostatic obstruction surgery (BPO), remain unclear. Aim of our study is to systematically report the evidence on management of post-operative transient urinary symptoms after BPO surgery.

Methods

A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist (PRISMA). PubMed, Embase, Scopus and Cochrane databases were searched up to March 2025. Studies evaluating pharmacotherapy, phytotherapy and/or physical treatment for post-operative transient LUTS in men aged were evaluated. Only randomized clinical trials (RCTs) were included.

Results

Overall, nine RCTs were included. Among the surgical techniques investigated, most data were available for transurethral resection of the prostate. The methods used to assess post-operative LUTS, as well as the timing of evaluation, varied considerably across studies. The most commonly submitted questionnaire was the International Prostate Symptom Score, and the most frequently performed diagnostic tool was uroflowmetry. Anticholinergic drugs seems to have the greatest efficacy in improving post-operative LUTS, even if the level of evidence is low. In contrast, alpha-blockers did not appear to offer significant additional benefits in this setting of patients. Phytocomplexes (Graminex G63, Curcumin complexes) were effective in improving patients’ quality of life (QoL) after BPO surgery. Pelvic floor muscle exercises (PFME) also demonstrated a reduction in symptom-related bother.

Conclusion

Current strategies for evaluating and managing transient postoperative LUTS are heterogeneous, and available evidence remains limited. Anticholinergic agents and phytotherapeutic compounds are among the most commonly prescribed treatments, though their efficacy is suboptimal. High-quality randomized trials are needed to provide robust clinical recommendations.

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Fig. 1: PRISMA flow chart of the systematic review.
Fig. 2: Risk of bias figure and summary.
Fig. 3

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Data availability

Data and material are available upon request

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Author notes

  1. These authors contributed equally: Giacomo Gallo, Riccardo Lombardo.

Authors and Affiliations

  1. Department of Urology, Sant’Andrea Hospital, ‘Sapienza’ University of Rome, Rome, Italy

    Giacomo Gallo, Riccardo Lombardo, Antonio Cicione, Antonio Franco & Cosimo De Nunzio

  2. Department of Urology, Charles Nicolle University Hospital, University of Rouen, Rouen, France

    Jean-Nicolas Cornu

  3. Department of Urology, Rush University Medical Center, Chicago, IL, USA

    Antonio Franco & Celeste Manfredi

  4. Department of Woman, Child and General and Specialized Surgery, University of Campania ‘Luigi Vanvitelli’, Naples, Italy

    Ferdinando Fusco & Celeste Manfredi

  5. Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

    Sachin Malde

  6. Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany

    Christopher Netsch

  7. alta uro AG, Basel, Switzerland; University of Basel, Basel, Switzerland

    Malte Rieken

  8. Medical School, University of Cyprus, Nicosia, Cyprus

    Stavros Gravas

  9. Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy

    Mauro Gacci

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Contributions

CDeN: substantial contributions to the conception and design of the work; drafting the work, final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. GG: substantial contributions to the conception and design of the work; substantial contributions to the acquisition, analysis, and interpretation of data for the work, drafting the work, final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. RL: substantial contributions to the conception and design of the work; substantial contributions to the acquisition, analysis, and interpretation of data for the work; drafting the work, final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AC: substantial contributions to the acquisition, analysis, and interpretation of data for the work; revising the work critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JNC: substantial contributions to the acquisition, analysis, and interpretation of data for the work; revising the work critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AF: substantial contributions to the acquisition, analysis, and interpretation of data for the work; revising the work critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. FF: revising the work critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SM: revising the work critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. CM: revising the work critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. CN: revising the work critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MR: revising the work critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SG: revising the work critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MG: revising the work critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Gallo, G., Lombardo, R., Cicione, A. et al. Evaluation and management of transient lower urinary tract symptoms (LUTS) after surgery for Benign prostatic obstruction (BPO): a systematic review. Prostate Cancer Prostatic Dis (2026). https://doi.org/10.1038/s41391-026-01082-y

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