The Evidence For and Against Prostate-Reducing Procedures for Men with Neurogenic Bladder

The evaluation of anatomic bladder outlet obstruction due to benign prostatic hyperplasia in patients with neurogenic bladder dysfunction can be a challenging and complex process for urologists. Lower urinary tract symptoms are non-specific, and the attribution of symptoms to underlying neurologic disease may result in withholding potentially beneficial therapies and procedures from patients with benign prostatic hyperplasia. Conversely, the underlying neurologic disorder may have profound effects on lower urinary tract symptoms and quality of life and must be considered in patient management decisions. Thorough evaluation is necessary to evaluate male patients with concomitant benign prostatic hyperplasia and neurogenic bladder with careful attention to the underlying neurologic disease. While surgical management of anatomic bladder outlet obstruction has a clear role in carefully selected and thoroughly evaluated patients with neurogenic bladder, treatment strategies must be individualized for each patient. This review seeks to explore the role of prostate-reducing surgeries in management of patients with neurogenic bladder and to compile evidence for and against these procedures in this population. Only a few studies have been published exploring prostate-reducing surgery in the management of patients with neurogenic bladder, with no recent trials. These existing studies are poorly controlled and are characterized by small, heterogeneous study populations, retrospective design, and high risk of bias. While some studies suggest positive outcomes from prostate-reducing surgery for management of patients with neurogenic bladder, more high-quality trials are needed.