The effect of bladder function on the efficacy of transurethral prostatectomy in patients with benign prostatic hyperplasia: a retrospective, single-center study

Jin Li; Xian-Yan-Ling Yi; Ze-Yu Chen; Bo Chen; Yin Huang; Da-Zhou Liao; Pu-Ze Wang; De-Hong Cao; Jian-Zhong Ai; Liang-Ren Liu

doi:10.4103/aja202327

. 2023 Aug 11;26(1):112–118. doi: 10.4103/aja202327

The effect of bladder function on the efficacy of transurethral prostatectomy in patients with benign prostatic hyperplasia: a retrospective, single-center study

Jin Li ^1,^2,^*, Xian-Yan-Ling Yi ^1,^2,^*, Ze-Yu Chen ^1,², Bo Chen ^1,², Yin Huang ^1,², Da-Zhou Liao ¹, Pu-Ze Wang ^1,², De-Hong Cao ², Jian-Zhong Ai ^2,^✉, Liang-Ren Liu ^2,^✉

PMCID: PMC10846830 PMID: 37594295

Abstract

We investigated the impact and predictive value of bladder function in patients with benign prostatic hyperplasia (BPH) on the efficacy of transurethral prostatectomy. Symptomatic, imaging, and urodynamic data of patients who underwent transurethral prostatectomy at West China Hospital of Sichuan University (Chengdu, China) from July 2019 to December 2021 were collected. Follow-up data included the quality of life (QoL), International Prostate Symptom Score (IPSS), and IPSS storage and voiding (IPSS-s and IPSS-v). Moreover, urinary creatinine (Cr), nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), and prostaglandin estradiol (PGE2) were measured in 30 patients with BPH and 30 healthy participants. Perioperative indicators were determined by subgroup analyses and receiver operating characteristic (ROC) curve analysis. Among the 313 patients with BPH included, patients with severe micturition problems had more improvements but higher micturition grades postoperatively than those with moderate symptoms. Similarly, good bladder sensation, compliance, and detrusor contractility (DC) were predictors of low postoperative IPSS and QoL. The urinary concentrations of BDNF/Cr, NGF/Cr, and PGE2/Cr in patients were significantly higher than those in healthy participants (all P < 0.001). After evaluation, only DC was significantly related to both urinary indicators and postoperative recovery of patients. Patients with good DC, as predicted by urinary indicators, had lower IPSS and IPSS-v than those with reduced DC at the 1^st month postoperatively (both P < 0.05). In summary, patients with impaired bladder function had poor recovery. The combined levels of urinary BDNF/Cr, NGF/Cr, and PGE2/Cr in patients with BPH may be valid predictors of preoperative bladder function and postoperative recovery.

Keywords: BPH, function of bladder, IPSS, urodynamics

INTRODUCTION

Benign prostatic hyperplasia (BPH), manifested as lower urinary tract symptoms (LUTS), is a frequently occurring disease in middle-aged and elderly men. Histologically, BPH is characterized by prostatic enlargement and bladder outlet obstruction (BOO), which trigger the levitated internal pressure of the bladder. Consequently, the bladder wall thickens and detrusor contractility (DC) increases due to smooth muscle hypertrophy and accumulated collagen fibers in the compensatory stage. During this period, the bladder is usually accompanied by uninhibited contraction (UIC), also known as detrusor overactivity (DO). In the decompensation period, detrusor underactivity (DU) occurs ubiquitously, and complications resulting from dysfunctional urinary systems greatly impact the quality of life (QoL) of patients with BPH.

It is widely acknowledged that removing BOO is crucial for patients with BPH to recover micturition. A previous study has shown that after 20 years of follow-up, transurethral resection of the prostate (TURP) and other procedures can significantly improve the International Prostate Symptom Score (IPSS) and QoL of patients with BPH by eliminating BOO.1 As science advances, oral drugs, green laser photoselective vaporization of the prostate (PVP), prostate stents, and other modalities are gradually being applied in patients with BPH. However, patients can still experience LUTS owing to the impaired bladder after surgery.2 In addition, patients who are insensitive to oral drugs can gradually develop serious complications after long-term medication, by which point they will have missed the optimal time for surgery. From this perspective, the surgical indications recommended by the current guidelines for patients with BPH largely ignore bladder function, which may adversely affect their recovery.

Bladder function can be described by parameters related to bladder morphology, pressure, contractility, and sensitivity through LUTS, imaging data, and urodynamic studies (UDS). However, controversies regarding the interpretations of these indicators are blocking their universal applications.3,4 Interestingly, despite its critical role in assessing bladder functions, invasive UDS is unsuitable for some patients with BPH; therefore, some researchers have turned to urinary molecule detection as an alternative. Levitated intravesical pressure stimulates muscle cells and epithelial cells to release small molecules such as nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), and prostaglandin estradiol (PGE2).5 However, the sensitivity and specificity of urinary molecules to reflect bladder function have not yet been unified, and their predictive value in the postoperative recovery of patients with BPH has not been revealed.

Early assessments of bladder function in patients with BPH may offer real-time illustrations of impairment in bladder function and decrease the probabilities of developing end-stage BPH. Therefore, we integrated preoperative symptoms, imaging data, UDS data, and urinary indicators to comprehensively unravel the impact of bladder function on surgical efficacy, which may provide a novel insight into the choice of operation time for patients with BPH.

PARTICIPANTS AND METHODS

Patients and healthy participants

The Institutional Review Board-approved database comprised patients with BPH who underwent TURP and PVP at the West China Hospital of Sichuan University (Chengdu, China). The inclusion criteria of the study group were as follows: (1) patients with surgical indications, such as refractory urinary retention, recurrent urinary tract infections, recurrent bladder stones or hematuria, and renal insufficiency caused by BPH;6 (2) patients with BPH with complete UDS reports; (3) surgery duration between July 2019 and December 2021; and (4) patients who were pathologically diagnosed as BPH. The control group comprised 30 recruited healthy participants without LUTS. The exclusion criteria of both the groups were as follows: (1) pathologically diagnosed as prostate or bladder cancer; (2) neurogenic bladder; (3) severe systemic infections and urinary tuberculosis; (4) urethral stricture; (5) prior pelvic radiotherapy, surgery, or pelvic fracture; or (6) had taken α-/M-receptor blockers within the past 2 weeks. The morning first urine samples of 30 consecutive patients with BPH and 30 healthy men were collected for detection. Ethical approval was obtained at the West China Hospital of Sichuan University (Approval No. 2022-356). All patients and healthy participants were in accordance with the principle of ethics and signed relevant informed consent forms.

Methods

The general information and symptoms of patients with BPH were retrieved, and the severity of LUTS (IPSS) and their impact on patients (QoL) were collected (Supplementary Table 1).7 The patients were categorized into the following three IPSS groups: mild (0–7), moderate (8–19), and severe (20–35). Similarly, patients were subdivided into mild (0–5), moderate (6–10), and severe (11–15) IPSS storage (IPSS-s) groups by IPSS-s (sum of frequency, urgency, and nocturia in IPSS), and subdivided into mild (0–6), moderate (7–13), and severe (14–20) IPSS voiding (IPSS-v) groups by IPSS-v (sum of incomplete emptying, intermittency, weak stream, and straining in IPSS). Furthermore, most patients with BPH were affected by LUTS and complications, and their average levels of QoL were closer to less satisfied as a result. Accordingly, to differentiate the QoL levels, patients with BPH were divided into tolerable (0–4) and intolerable (5–6) QoL groups. At the 1^st, 6^th, and 12^th months postoperatively, the patients were followed up by telephone to assess postoperative recovery, including IPSS, IPSS-s, IPSS-v, and QoL. Successful improvements of IPSS, IPSS-s, IPSS-v, and QoL were defined as postoperative level/preoperative level ≤0.50.

Supplementary Table 1.

International Prostate Symptom Score and quality of life

In the past month	Not at all		<1 in 5 times	Less than half the time	About half the time	More than half the time	Almost always
1. Incomplete emptying	0		1	2	3	4	5
2. Frequency	0		1	2	3	4	5
3. Intermittency	0		1	2	3	4	5
4. Urgency	0		1	2	3	4	5
5. Weak stream	0		1	2	3	4	5
6. Straining	0		1	2	3	4	5
	None		1 time	2 times	3 times	4 times	5 times
7. Nocturia	0		1	2	3	4	5

QoL due to urinary symptoms	Delighted	Pleased	Mostly satisfied	Mixed	Mostly dissatisfied	Unhappy	Terrible

QoL score	0	1	2	3	4	5	6

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QoL: quality of life

Morphological indices including bladder wall thickness (BWT), prostate volume (PV), anterior posterior diameter of the prostate (APD), and postvoid residual urine (PVR) were measured by color Doppler ultrasonic examinations. APD contained <4 cm and ≥4 cm groups, and anterior BWT included normal (≤0.4 cm) and thickened (>0.4 cm) groups measured at a bladder volume of 150–200 ml.8 PV was calculated as 0.52 × length × width × height, involved small (<40 ml), medium (40–80 ml), and large (>80 ml) PV groups. PVR was calculated as 0.7 × length × width × height, involved mild (<50 ml), moderate (50–100 ml), and severe (>100 ml) PVR groups.9,10

UDSs were conducted by the same physician in accordance with Good Urodynamic Practice standards.11 UDS parameters included maximum cystometric capacity (MCC), bladder compliance (BC), bladder sensation (BS), UIC, BOO, DC, maximum flow rate (Qmax), detrusor pressure at Qmax (PdetQmax), urinary resistance factor (URA), and BOO index (BOOI). MCC included ≥200 ml and <200 ml groups, and Qmax involved ≥10 ml s⁻¹ and <10 ml s⁻¹ groups. BC was calculated by dividing the volume change by the detrusor pressure change during the change in bladder volume, and decreased and good BC was defined as <40 ml per cmH₂O and ≥40 ml per cmH₂O, respectively.12 According to the linear passive urethral resistance relationship (LinPURR) nomogram, BOO contains existing (grade 0–I), suspicious (grade II), and no BOO (grade III–VI) groups, and DC comprises good DC (N [normal]–, N+ and ST [strong] zones) and DU (VW [very weak], W [weak]–, and W+ zones).12 During instillations, UIC was defined as an obvious change in detrusor pressure (≥15 cmH₂O), and BS was conceptualized as the awareness of bladder filling and increasing sensation up to a desire to void, which numerically equals the first sensation volume (<100 ml, sensitive; 100–200 ml, good; and >200 ml, reduced).13,14 BOOI15 was calculated as PdetQmax−2×Qmax, and patients were divided into mild (<20), moderate (20–40), and severe (>40) BOOI groups. URA was calculated as ([1+4dQ²×PdetQmax]^1/2–1)/(2dQmax²), wherein d=3.8×10⁻⁴, and patients were divided into ≥28.9884 cmH₂O and <28.9884 cmH₂O groups.16

The first-morning urine samples of patients and healthy men were collected and transferred to the laboratory within 1 h. Samples were centrifuged (Thermo Fisher Scientific Inc., Waltham, MA, USA; 4°C, 4000g, and 10 min) and the supernatants were subdivided into 1.5 ml tubes. The urinary levels of BDNF, NGF, and PGE2 (in pg ml⁻¹) were detected by enzyme-linked immunosorbent assay (ELISA) kits for BDNF (E-EL-H0010c, Elabscience, Wuhan, China), NGF (E-EL-H1205c, Elabscience), and PGE2 (E-EL-H0034c, Elabscience), respectively, and normalized by urinary Cr (in mg dl⁻¹).

SPSS 26.0 (SPSS Inc., Chicago, IL, USA) and GraphPad Prism 9.0 (GraphPad Software Inc., San Diego, CA, USA) were used for statistical analysis. Normally and nonnormally distributed variables were expressed as mean ± standard deviation (s.d.) and median (interquartile range [IQR]), respectively. Student’s t-test and rank sum test were applied to normally and nonnormally distributed data, respectively, and Chi-square test was used to evaluate categorical variable data. Correlations between indicators were estimated by Kendall’s tau-b test. Preoperative indicators significantly related to postoperative or urinary indicators were analyzed by generalized estimating equations (GEEs). Receiver operating characteristic (ROC) curves and area under the curve (AUC) were used for diagnostic accuracy and cutoff determination of biomarkers. Patients were further divided into subgroups according to the diagnostic threshold of preoperative indicators significantly identified both in the ROC and GEE analyses. P < 0.05 was considered statistically significant.

RESULTS

In total, 513 patients with BPH were identified and 313 patients with a medium age of 68.0 years were included in the analysis. The preoperative and postoperative indicators of patients are described in Table 1 and Supplementary Table 2. The correlations between LUTS, imaging data, UDS data, and surgical outcomes at the 1^st, 6^th, and 12^th postoperative months are displayed in Supplementary Table 3–5, and the indicators with possible significance were included in GEE analysis (Supplementary Table 6–9) and intergroup analysis (Supplementary Table 6–17).

Table 1.

Characteristics of perioperative indicators of patients with benign prostatic hyperplasia

Characteristic	Value, median (IQR)
Age (year)	68.0 (62.5–74.0)
BMI (kg m⁻²)	23.67 (21.93–24.47)
Course of disease (month)	36.0 (12.0–72.0)
PV (ml)	44.60 (33.28–66.98)
BWT (cm)	0.40 (0.30–0.60)
PVR (ml)	59.00 (0.0–153.50)
MCC (ml)	204.00 (181.50–227.50)
PdetQmax (cmH₂O)	60.00 (25.50–90.50)
Qmax (ml s⁻¹)	6.00 (2.00–9.50)
BOOI	45.00 (13.00–77.00)
URA (cmH₂O)	33.58 (19.42–51.74)
Preoperative IPSS	21.00 (17.00–24.00)
Preoperative IPSS-s	10.00 (8.00–12.00)
Preoperative IPSS-v	11.00 (9.00–14.00)
Preoperative QoL	5.00 (5.00–6.00)
APD (cm)	4.30 (3.80–4.80)
IPSS at the postoperative 1^st month	1.00 (1.00–1.00)
IPSS-s at the postoperative 1^st month	1.00 (1.00–1.00)
IPSS-v at the postoperative 1^st month	1.00 (1.00–1.00)
QoL at the postoperative 1^st month	1.00 (0–1.00)
IPSS at the postoperative 6^th month	1.00 (1.00–1.00)
IPSS-s at the postoperative 6^th month	1.00 (1.00–1.00)
IPSS-v at the postoperative 6^th month	1.00 (1.00–1.00)
QoL at the postoperative 6^th month	1.00 (0–1.00)
IPSS at the postoperative 12^th month	1.00 (1.00–1.00)
IPSS-s at the postoperative 12^th month	1.00 (1.00–1.00)
IPSS-v at the postoperative 12^th month	1.00 (1.00–1.00)
QoL at the postoperative 12^th month	1.00 (0–1.00)

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APD: anterior posterior diameter of the prostate; BOOI: bladder outlet obstruction index; BWT: bladder wall thickness; IPSS: International Prostate Symptom Score; IPSS-s: IPSS storage; IPSS-v: IPSS voiding; IQR: interquartile range; MCC: maximum cystometric capacity; Qmax: maximum flow rate; PdetQmax: detrusor pressure at Qmax; PV: prostate volume; PVR: postvoid residual urine; QoL: quality of life; URA: urinary resistance factor; BMI: body mass index

Supplementary Table 2.

Frequency of preoperative indicators in patients with benign prostatic hyperplasia

Preoperative indicators	Frequency (%)
IPSS
Mild	3 (1.0)
Moderate	118 (37.7)
Severe	192 (61.3)
IPSS-s
Mild	25 (8.0)
Moderate	169 (54.0)
Severe	119 (38.0)
IPSS-v
Mild	31 (9.9)
Moderate	197 (62.9)
Severe	85 (27.2)
QoL
Good	69 (22.0)
Poor	244 (78.0)
Course of disease (month)
≤24	129 (41.2)
>24	184 (58.8)
Age (year)
<70	182 (58.1)
≥82	131 (41.9)
Dysuria
No	231 (73.8)
Yes	82 (26.2)
Type of surgery
TURP	77 (24.6)
PVP	236 (75.4)
MCC (ml)
<200	208 (66.5)
≥200	105 (33.5)
APD (cm)
<4	90 (28.8)
≥4	223 (71.2)
BWT
Normal	220 (70.3)
Thickened	93 (29.7)
DC
Reduced	150 (47.9)
Good	163 (52.1)
UIC
No	226 (72.2)
Yes	87 (27.8)
BC
Reduced	42 (13.4)
Good	271 (86.6)
Qmax (ml/s)
<10	297 (94.9)
≥10	16 (5.1)
PdetQmax (cmH₂O)
<40	110 (35.1)
≥40	203 (64.9)
URA (cmH₂O)
<28.9884	125 (39.9)
≥28.9884	188 (60.1)
PV
Small	125 (39.9)
Medium	142 (45.4)
Large	46 (14.7)
PVR (ml)
<50	147 (47.0)
50–100	44 (14.1)
>100	122 (39.0)
BS
Reduced	61 (19.5)
Sensitive	72 (23.0)
Good	180 (57.5)
BOOI
<20	88 (28.1)
20–40	59 (18.8)
>40	166 (53.0)
BOO
No	2 (0.6)
Suspicious	139 (44.4)
Yes	172 (55.0)

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APD: anterior posterior diameter of the prostate; BC: bladder compliance; BOO: bladder outlet obstruction; BOOI: bladder outlet obstruction index; BS: bladder sensation; BWT: bladder wall thickness; DC: detrusor contractility; IPSS: International Prostate Symptom Score; IPSS-s: IPSS (storage); IPSS-v: IPSS (voiding); MCC: maximum cystometric capacity; Qmax: maximum flow rate; PdetQmax: detrusor pressure at Qmax; PV: prostate volume; PVR: postvoid residual urine; QoL: quality of life; UIC: uninhibited contraction; URA: urinary resistance factor; TURP: transurethral resection of prostate; PVP: photoselective vaporization of the prostate

Supplementary Table 3.

Correlation analysis between preoperative indicators and their improvements at the postoperative 1^st month in patients with benign prostatic hyperplasia

Preoperative indicators	r/P	QoL change	IPSS change	IPSS-s change	IPSS-v change	Preoperative indicators	r/P	QoL change	IPSS change	IPSS-s change	IPSS-v change
IPSS	r	0.187**	0.061	0.200**	0.012	PVR	r	0.062	−0.027	0.017	−0.008
	P	0.000	0.201	0.000	0.801		P	0.194	0.566	0.726	0.870
IPSS-s	r	0.019	0.033	0.240**	−0.020	BWT	r	0.075	−0.035	0.061	−0.001
	P	0.691	0.499	0.000	0.679		P	0.127	0.481	0.212	0.982
IPSS-v	r	0.245**	0.055	0.082	0.032	APD	r	0.001	0.065	0.036	0.035
	P	0.000	0.252	0.087	0.510		P	0.985	0.169	0.451	0.459
QoL	r	0.362**	−0.013	0.095	−0.003	MCC	r	0.045	0.016	−0.006	0.013
	P	0.000	0.802	0.072	0.952		P	0.336	0.724	0.889	0.774
Age	r	−0.019	−0.054	−0.142**	−0.019	BS	r	0.125*	−0.022	0.003	0.000
	P	0.693	0.250	0.003	0.692		P	0.016	0.678	0.957	0.993
BMI	r	−0.105	−0.008	0.045	−0.096	UIC	r	−0.013	0.075	0.051	0.031
	P	0.057	0.884	0.419	0.082		P	0.817	0.187	0.364	0.583
Course of disease	r	−0.068	−0.103*	−0.008	−0.083	BC	r	−0.033	−0.029	0.064	−0.003
	P	0.156	0.031	0.866	0.083		P	0.559	0.599	0.250	0.951
Urinary retention	r	0.163**	0.079	0.079	0.064	DC	r	−0.003	0.075	0.094	0.053
	P	0.004	0.161	0.161	0.257		P	0.950	0.170	0.085	0.329
Hematuria	r	−0.027	−0.013	0.051	−0.025	BOO	r	0.021	0.076	0.031	0.025
	P	0.629	0.820	0.364	0.663		P	0.713	0.178	0.581	0.652
Dysuria	r	−0.020	0.037	0.057	0.022	Qmax	r	−0.025	−0.073	−0.039	−0.026
	P	0.721	0.515	0.316	0.701		P	0.607	0.133	0.419	0.597
PV	r	0.030	0.078	0.061	0.032	BOOI	r	0.047	0.095*	0.118*	0.068
	P	0.514	0.096	0.187	0.492		P	0.314	0.042	0.012	0.147
Bladder stone	r	0.064	−0.010	0.043	−0.045	URA	r	0.052	0.086	0.098*	0.060
	P	0.257	0.865	0.452	0.425		P	0.262	0.065	0.034	0.196
Type of surgery	r	0.150**	0.058	0.022	0.070
P	0.008	0.304	0.704	0.216

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*P<0.05; **P<0.01. APD: anterior posterior diameter of the prostate; BC: bladder compliance; BMI: body mass index; BOO: bladder outlet obstruction; BOOI: BOO index; BS: bladder sensation; BWT: bladder wall thickness; DC: detrusor contractility; IPSS: International Prostate Symptom Score; IPSS-s: IPSS (storage); IPSS-v: IPSS (voiding); MCC: maximum cystometric capacity; PV: prostate volume; PVR: postvoid residual urine; Qmax: maximum flow rate; QoL: quality of life; UIC: uninhibited contraction; URA: urinary resistance factor

Supplementary Table 5.

Correlation analysis between preoperative indicators and their improvements at the postoperative 12^th month in patients with benign prostatic hyperplasia

Preoperative indicators	r/P	QoL change	IPSS change	IPSS-s change	IPSS-v change	Preoperative indicators	r/P	QoL change	IPSS change	IPSS-s change	IPSS-v change
IPSS	r	0.039	−0.023	0.052	−0.008	PVR	r	−0.002	−0.042	0.019	−0.041
	P	0.474	0.674	0.337	0.880		P	0.977	0.436	0.729	0.454
IPSS-s	r	−0.035	0.012	0.102	−0.008	BWT	r	0.080	−0.051	0.102	−0.036
	P	0.520	0.833	0.064	0.885		P	0.148	0.357	0.066	0.509
IPSS-v	r	0.089	−0.048	−0.018	−0.016	APD	r	−0.043	−0.002	0.002	0.050
	P	0.103	0.379	0.738	0.775		P	0.421	0.975	0.973	0.346
QoL	r	0.257**	−0.078	0.036	−0.023	MCC	r	0.046	0.003	0.083	0.037
	P	0.000	0.195	0.555	0.697		P	0.384	0.954	0.113	0.477
Age	r	−0.088	−0.038	−0.184**	−0.040	BS	r	0.118*	0.025	0.108	0.010
	P	0.097	0.470	0.001	0.446		P	0.045	0.672	0.066	0.863
BMI	r	0.016	−0.003	−0.054	0.036	UIC	r	−0.048	0.037	−0.099	0.037
	P	0.800	0.966	0.381	0.558		P	0.449	0.565	0.124	0.559
Course of disease	r	−0.074	−0.071	−0.090	−0.063	BC	r	0.186**	0.014	0.179**	−0.019
	P	0.167	0.188	0.093	0.238		P	0.003	0.827	0.005	0.764
Urinary retention	r	0.076	0.039	0.011	0.039	DC	r	0.066	0.137*	0.164**	0.120
	P	0.234	0.543	0.859	0.541		P	0.284	0.025	0.008	0.051
Hematuria	r	0.130*	−0.016	0.071	−0.076	BOO	r	0.071	0.097	0.079	0.105
	P	0.042	0.802	0.269	0.233		P	0.267	0.129	0.215	0.101
Dysuria	r	0.114	0.070	0.051	0.032	Qmax	r	0.023	0.053	0.063	0.033
	P	0.075	0.273	0.426	0.614		P	0.676	0.332	0.245	0.545
PV	r	−0.035	0.023	0.018	0.066	BOOI	r	0.061	0.116*	0.121*	0.106*
	P	0.508	0.665	0.733	0.213		P	0.247	0.028	0.022	0.045
Bladder stone	r	0.035	−0.037	−0.030	−0.071	URA	r	0.077	0.100	0.094	0.089
	P	0.580	0.566	0.636	0.271		P	0.144	0.056	0.073	0.090
Type of surgery	r	0.048	−0.011	−0.007	−0.063
	P	0.455	0.859	0.917	0.326

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**P<0.01; *P<0.05. APD: anterior posterior diameter of the prostate; BMI: body mass index; BC: bladder compliance; BOO: bladder outlet obstruction; BOOI: BOO index; BS: bladder sensation; BWT: bladder wall thickness; DC: detrusor contractility; IPSS: International Prostate Symptom Score; IPSS-s: IPSS (storage); IPSS-v: IPSS (voiding); MCC: maximum cystometric capacity; PV: prostate volume; PVR: postvoid residual urine; Qmax: maximum flow rate; QoL: quality of life; UIC: uninhibited contraction; URA: urinary resistance factor

Supplementary Table 6.

Subgroup preoperative quality of life and the influence of preoperative indicators on quality of life improvement in patients with benign prostatic hyperplasia

	Preoperative QoL			QoL improvement

	Median (IQR)	Z	P	r	OR (95% CI)	P
Urinary retention (vs no)	5.00 (4.00–5.00)
Yes	6.00 (5.00–6.00)	−4.03	<0.001	−0.84	0.43 (0.12–1.6)	0.208
Hematuria (vs no)	5.00 (5.00–6.00)
Yes	5.00 (5.00–6.00)	−1.01	0.314	0.35	1.42 (0.83–2.42)	0.196
IPSS-s (vs severe)	5.00 (5.00–6.00)
Mild	5.00 (4.00–5.50)	−2.87	0.004	0.15	1.17 (0.56–2.4)	0.680
Moderate	5.00 (4.00–6.00)	−4.38	<0.001	0.12	1.13 (0.56–2.28)	0.739
Mild vs moderate		−0.55	0.581	−0.33	0.72 (0.46–1.11)	0.133
IPSS-v (vs severe)	6.00 (5.00–6.00)
Mild	4.00 (4.00–5.00)	−5.06	<0.001	−0.87	0.42 (0.22–0.81)	0.010
Moderate	5.00 (4.00–6.00)	−5.60	<0.001	−0.50	0.6 (0.34–1.09)	0.093
Mild vs moderate		−2.42	0.016	−0.39	0.68 (0.06–7.62)	0.754
IPSS (vs severe)	5.00 (5.00–6.00)
Mild	4.00 (3.00–-4.00)	-	-	−0.10	0.91 (0.08–10.14)	0.938
Moderate	5.00 (4.00–5.00)	−6.94	<0.001	−0.51	0.6 (0.42–0.87)	0.006
Mild vs moderate		-	-	−0.07	0.93 (0.63–1.36)	0.704
QoL (vs good)	4.00 (4.00–4.00)
Poor	5.00 (5.00–6.00)	−13.61	<0.001	1.26	3.53 (2.05–6.08)	<0.001
PV (vs small)	5.00 (5.00–6.00)
Medium	5.00 (5.00–6.00)	−0.84	0.403	0.10	1.1 (0.63–1.92)	0.736
Large	5.00 (5.00–6.00)	−0.74	0.462	0.50	1.66 (0.82–3.36)	0.162
Large vs medium		−0.28	0.778	0.48	1.62 (0.48–0.81)	<0.001
APD (vs <4 cm)	5.00 (5.00–6.00)
≥4 cm	6.00 (5.00–6.00)	−0.44	0.661	−0.02	0.98 (0.56–1.72)	0.950
BWT (vs ≤0.4 cm)	5.00 (5.00–5.50)
>0.4 cm	5.00 (5.00–6.00)	−1.59	0.113	0.27	1.3 (0.89–1.9)	0.168
PVR (vs mild)	5.00 (5.00–6.00)
Moderate	5.00 (5.00–6.00)	−0.09	0.929	0.55	1.73 (1–2.97)	0.048
Severe	5.00 (5.00–6.00)	−0.67	0.500	0.14	1.15 (0.78–1.7)	0.474
Severe vs moderate		−0.40	0.687	−0.40	0.67 (0.39–1.15)	0.146
Bladder stone (vs no)	5.00 (5.00–6.00)
Yes	5.00 (5.00–6.00)	−1.24	0.215	−0.15	0.86 (0.44–1.7)	0.663
Type of surgery (vs TURP)	5.00 (5.00–6.00)
PVP	5.00 (5.00–6.00)	−2.84	0.005	−0.13	0.88 (0.52–1.47)	0.615
MCC (vs <200 ml)	5.00 (5.00–6.00)
≥200 ml	5.00 (5.00–6.00)	−0.89	0.372	0.32	1.38 (0.94–2.02)	0.096
BS (vs reduced)	5.00 (4.00–6.00)
Sensitive	5.00 (4.00–5.00)	−2.15	0.032	−0.96	0.38 (0.22–0.66)	0.001
Good	5.00 (5.00–6.00)	−0.01	0.996	−0.03	0.97 (0.61–1.56)	0.905
Sensitive vs good		−2.99	0.003	−0.94	0.39 (0.25–0.6)	<0.001
UIC (vs no)	5.00 (5.00–6.00)
Yes	5.00 (4.00–6.00)	−0.17	0.863	0.04	1.04 (0.7–1.54)	0.852
BC (vs good)	6.00 (5.00–6.00)
Reduced	5.00 (5.00–6.00)	−1.34	0.180	−0.47	0.63 (0.37–1.08)	0.091
DC (vs reduced)	5.00 (5.00–6.00)
Good	5.00 (5.00–6.00)	−0.98	0.327	0.25	1.28 (0.9–1.84)	0.175
BOO (vs no)	4.00 (4.50–5.00)
Suspicious	5.00 (5.00–6.00)	-	-	−1.36	0.26 (0.03–2.08)	0.202
Yes	5.00 (5.00–6.00)	-	-	−1.22	0.3 (0.04–2.42)	0.256
Yes vs suspicious		−0.02	0.984	−0.15	0.86 (0.6–1.24)	0.432
Qmax (vs <10 ml/s)	5.00 (5.00–6.00)
≥10 ml/s	5.00 (5.00–6.00)	−1.11	0.269	0.18	1.19 (0.69–2.06)	0.531
BOOI (vs >40)	5.00 (4.25–6.00)
<20	5.00 (5.00–6.00)	−0.04	0.969	−0.30	0.74 (0.49–1.12)	0.157
20–40	5.00 (5.00–6.00)	−0.53	0.594	−0.08	0.92 (0.57–1.51)	0.751
20–40 vs <20		−0.49	0.625	0.22	1.24 (0.73–2.12)	0.421
URA (vs <28.9884 cmH₂O)	5.00 (4.00–6.00)
≥28.9884 cmH₂O	5.00 (5.00–6.00)	−0.99	0.323	0.14	1.15 (0.45–2.92)	0.775

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APD: anterior posterior diameter of the prostate; BC: bladder compliance; BOO: bladder outlet obstruction; BOOI: BOO index; BS: bladder sensation; BWT: bladder wall thickness; DC: detrusor contractility; IPSS: International Prostate Symptom Score; IPSS-s: IPSS (storage); IPSS-v: IPSS (voiding); IQR: interquartile range; MCC: maximum cystometric capacity; PV: prostate volume; PVR: postvoid residual urine; Qmax: maximum flow rate; QoL: quality of life; UIC: uninhibited contraction; URA: urinary resistance factor; CI: confidence interval; OR: odds ratio; TURP: transurethral resection of prostate; PVP: photoselective vaporization of the prostate

Supplementary Table 9.

Subgroup preoperative International Prostate Symptom Score (voiding) and the influence of preoperative indicators on International Prostate Symptom Score (voiding) improvement in patients with benign prostatic hyperplasia

	Preoperative IPSS-v			IPSS-v improvement

	Median (IQR)	Z	P	r	OR (95%CI)	P
Urinary retention (vs no)	11.00 (9.00–13.00)
Yes	12.00 (10.00–14.00)	−2.72	0.007	0.73	2.073 (0.784–5.485)	0.142
Hematuria (vs no)	11.00 (9.00–14.00)
Yes	12.00 (9.00–14.00)	−0.50	0.620	0.53	1.699 (0.668–4.319)	0.266
IPSS-s (vs severe)	12.00 (10.00–15.00)
Mild	9.00 (7.00–12.00)	−3.66	<0.001	0.45	1.530 (0.335–6.992)	0.583
Moderate	11.00 (9.00–13.00)	−4.61	<0.001	−0.06	0.938 (0.439–2.005)	0.869
Mild vs moderate	-	−1.58	0.113	0.49	1.630 (0.339–6.657)	0.469
IPSS-v (vs severe)	15.00 (14.00–15.00)
Mild	5.00 (3.00–6.00)	−8.41	<0.001	0.78	1.94 (0.553–6.808)	0.251
Moderate	11.00 (9.00–13.00)	−13.41	<0.001	1.04	3.024 (0.986–9.278)	0.087
Mild vs moderate	-	−9.03	<0.001	−0.94	0.392 (0.056–2.77)	0.348
IPSS (vs severe)	13.00 (11.00–14.00)
Mild	3.00 (1.00–4.00)	-	-	−0.91	0.404 (0.061–2.654)	0.345
Moderate	9.00 (7.00–10.00)	−12.22	<0.001	0.03	1.030 (0.402–2.637)	0.951
Mild vs moderate	-	-	-	0.33	1.345 (0.540–3.355)	0.472
QoL (vs ≤4)	9.00 (7.00–10.50)
5–6	12.00 (10.00–14.00)	−7.21	<0.001	−0.87	0.418 (0.123–1.421)	0.163
PV (vs small)	12.00 (9.00–14.00)
Medium	11.00 (9.00–13.00)	−0.24	0.808	−0.71	0.492 (0.106–2.280)	0.364
Large	12.00 (8.00–14.00)	−1.33	0.183	0.78	2.181 (0.178–26.679)	0.542
Large vs medium	-	−0.71	0.476	0.24	1.272 (0.377–4.293)	0.698
APD (vs <4 cm)	11.00.5 (9.00–14.00)
≥4 cm	14.00 (11.00–15.00)	−1.10	0.272	0.01	1.006 (0.225–4.488)	0.994
BWT (vs ≤0.4 cm)	11.00 (9.00–13.00)
>0.4 cm	12.00 (9.00–14.00)	−2.17	0.030	−0.45	0.635 (0.225–1.790)	0.391
PVR (vs mild)	11.00 (9.00–14.00)
Moderate	11.00 (10.00–13.00)	−0.66	0.507	1.12	3.070 (0.670–14.073)	0.144
Severe	11.00 (9.00–14.00)	−0.75	0.452	0.07	0.839 (0.346–2.035)	0.877
Severe vs moderate	-	−0.16	0.870	−1.05	0.273 (0.060–1.240)	0.185
Bladder stone (vs no)	11.00 (9.00–14.00)
Yes	12.00 (10.00–15.00)	−1.92	0.055	−1.03	0.358 (0.107–1.203)	0.097
Type of surgery (vs TURP)	11.00 (9.00–13.00)
PVP	11.00 (9.00–15.00)	−1.31	0.189	−0.55	0.578 (0.195–1.714)	0.323
MCC (vs <200 ml)	11.00 (9.00–13.75)
≥200 ml	12.00 (9.00–14.00)	−0.71	0.479	−0.07	0.929 (0.351–2.462)	0.883
BS (vs reduced)	11.00 (9.00–13.00)
Sensitive	11.00 (9.00–14.00)	−0.18	0.854	−0.32	0.728 (0.200–2.648)	0.630
Good	12.00 (9.00–14.00)	−1.09	0.276	0.45	1.572 (0.513–4.819)	0.429
Sensitive vs good	-	−1.37	0.171	−0.69	0.500 (0.177–1.410)	0.190
UIC (vs no)	11.00 (9.00–14.00)
Yes	12.00 (9.00–14.00)	−0.93	0.354	0.00	0.999 (0.377–2.646)	0.998
BC (vs good)	14.00 (11.00–15.00)
Reduced	12.00 (9.75–14.00)	−1.05	0.294	0.12	1.132 (0.279–4.593)	0.862
DC (vs reduced)	11.00 (9.00–14.00)
Good	12.00 (9.00–13.25)	−0.84	0.399	1.27	3.553 (1.385–9.116)	0.008
BOO (vs no)^#	9.50 (5.00–12.00)
Suspicious	11.00 (9.00–14.00)	-	-	-	-	-
Yes	11.00 (9.00–14.00)	-	-	-	-	-
Yes vs suspicious	-	−0.30	0.778	-	-	-
Qmax (vs <10 ml/s)	11.00 (9.00–14.00)
≥10 ml/s	12.00 (9.00–13.00)	−0.10	0.923	1.67	5.302 (0.636–44.225)	0.123
BOOI (vs >40)	11.00 (9.25–14.00)
<20	11.00 (9.00–14.00)	−0.06	0.95	−0.68	0.504 (0.187–1.362)	0.177
20–40	11.00 (9.00–14.00)	−0.45	0.651	−0.57	0.567 (0.178–1.802)	0.336
20–40 vs <20	-	−0.42	0.675	0.12	1.124 (0.343–3.683)	0.847
URA (vs <28.9884 cmH₂O)	11.00 (9.00–13.00)
≥28.9884 cmH₂O	12.00 (9.00–14.00)	−1.14	0.253	0.25	1.284 (0.173–9.552)	0.807

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^#Data may contain multicollinearity or complete separation: Which is not suitable for GEE analysis. APD: anterior posterior diameter of the prostate; BC: bladder compliance; BOO: bladder outlet obstruction; BOOI: BOO index; BS: bladder sensation; BWT: bladder wall thickness; DC: detrusor contractility; IPSS: International Prostate Symptom Score; IPSS-s: IPSS (storage); IPSS-v: IPSS (voiding); IQR: interquartile range; MCC: maximum cystometric capacity; PV: prostate volume; PVR: postvoid residual urine; Qmax: maximum flow rate; QoL: quality of life; UIC: uninhibited contraction; URA: urinary resistance factor; GEE: generalized estimating equation; OR: odds ratio; CI: confidence interval; TURP: transurethral resection of prostate; PVP: photoselective vaporization of the prostate

Supplementary Table 17.

Comparison of postoperative International Prostate Symptom Score (voiding) in subgroups of patients with benign prostatic hyperplasia

	IPSS-v at the postoperative 1^st month			IPSS-v at the postoperative 6^th month			IPSS-v at the postoperative 12^th month

	Median (IQR)	Z	P	Median (IQR)	Z	P	Median (IQR)	Z	P
IPSS-s (vs severe)	0 (0–1.50)			0 (0–1.00)			0 (0–1.00)
Mild	0 (0–2.00)	−1.33	0.183	0 (0–0)	−1.94	0.053	0 (0–0)	−2.52	0.012
Moderate	0 (0–0)	−2.41	0.016	0 (0–1.00)	−0.98	0.326	0 (0–1.00)	−0.49	0.627
Mild vs moderate	-	−0.13	0.898	-	−1.47	0.142	-	−2.36	0.018
IPSS-v (vs severe)	0 (0–2.00)			0 (0–1.00)			0 (0–2.00)
Mild	0 (0–2.00)	−0.64	0.520	0 (0–1.00)	−0.68	0.498	0 (0–1.00)	−0.93	0.355
Moderate	0 (0–1.00)	−1.30	0.195	0 (0–1.00)	−1.62	0.106	0 (0–0)	−2.77	0.005
Mild vs moderate	-	−0.18	0.856	-	−0.32	0.751	-	−0.92	0.360
IPSS (vs severe)	0 (0–1.00)			0 (0–1.00)			0 (0–2.00)
Mild	0 (0)	-	-	0 (0–0)	-	-	0 (0–0)	-	-
Moderate	0 (0–2.00)	−0.59	0.554	0 (0–0)	−1.21	0.227	0 (0–0)	−2.53	0.011
Mild vs moderate	-	−0.11	0.944	-	−0.91	0.541	-	−0.82	0.600
QoL (vs good)	0 (0–0.50)			0 (0–1.00)			0 (0–0.50)
Poor	0 (0–1.00)	−1.10	0.273	0 (0–1.00)	−0.38	0.706	0 (0–1.00)	−0.73	0.464
PV (vs small)	0 (0–1.00)			0 (0–0)			0 (0–0)
Medium	0 (0–1.00)	−0.17	0.863	0 (0–1.00)	−1.48	0.138	0 (0–1.00)	−1.65	0.098
Large	0 (0–1.00)	−0.24	0.810	0 (0–1.00)	−0.39	0.696	0 (0–2.00)	−1.81	0.071
Large vs medium	-	−0.37	0.709	-	−0.65	0.515	-	−0.63	0.532
BWT (vs ≤0.4 cm)	0 (0–1.00)			0 (0–1.00)			0 (0–1.75)
>0.4 cm	0 (0–1.00)	−0.23	0.816	0 (0–1.00)	−1.06	0.291	0 (0–1.00)	−0.88	0.378
APD (vs <4 cm)	0 (0–2.00)			0 (0–0.25)			0 (0–1.00)
≥4 cm	0 (0–1.00)	−1.84	0.065	0 (0–1.00)	−0.24	0.813	0 (0–1.00)	−0.51	0.608
BS (vs reduced)	0 (0–1.00)			0 (0–1.00)			0 (0–2.00)
Sensitive	0 (0–1.00)	−0.78	0.437	0 (0–1.00)	−0.77	0.443	0 (0–1.00)	−0.10	0.922
Good	0 (0–2.00)	−1.49	0.135	0 (0–0.75)	−0.02	0.981	0 (0–1.00)	−0.78	0.438
Sensitive vs good	-	−0.67	0.506	-	−1.00	0.317	-	−0.83	0.406
UIC (vs no)	0 (0–1.75)			0 (0–1.00)			0 (0–1.00)
Yes	0 (0–1.00)	−0.69	0.490	0 (0–0)	−1.01	0.313	0 (0–0)	−1.19	0.234
BC (vs good)	0 (0–1.00)			0 (0–1.00)			0 (0–1.00)
Reduced	0 (0–1.00)	−0.22	0.830	0 (0–1.00)	−1.06	0.287	0 (0–2.00)	−0.59	0.553
DC (vs reduced)	0 (0–2.00)			0 (0–1.00)			0 (0–1.75)
Good	0 (0–0)	−2.51	0.012	0 (0–0)	−0.73	0.468	0 (0–1.00)	−1.12	0.263
BOOI (vs >40)	0 (0–0.25)			0 (0–1.00)			0 (0–1.00)
<20	0 (0–2.00)	−1.59	0.111	0 (0–1.00)	−0.04	0.966	0 (0–2.00)	−1.28	0.201
20–40	0 (0–2.00)	−2.00	0.045	0 (0–1.00)	−0.16	0.875	0 (0–0)	−0.78	0.434
20–40 vs <20	-	−0.49	0.623	-	−0.20	0.839	-	−1.61	0.109

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APD: anterior posterior diameter of the prostate; BC: bladder compliance; BOOI: bladder outlet obstruction index; BS: bladder sensation; BWT: bladder wall thickness; DC: detrusor contractility; IPSS: International Prostate Symptom Score; IPSS-s: IPSS (storage); IPSS-v: IPSS (voiding); IQR: interquartile range; PV: prostate volume; QoL: quality of life; UIC: uninhibited contraction

Supplementary Table 4.

Correlation analysis between preoperative indicators and their improvements at the postoperative 6^th month in patients with benign prostatic hyperplasia

Preoperative indicators	r/P	QoL change	IPSS change	IPSS-s change	IPSS-v change	Preoperative indicators	r/P	QoL change	IPSS change	IPSS-s change	IPSS-v change
IPSS	r	0.048	0.020	0.129**	0.000	PVR	r	0.045	−0.039	0.040	−0.016
	P	0.314	0.670	0.007	0.994		P	0.340	0.413	0.399	0.743
IPSS-s	r	−0.024	0.071	0.188**	0.018	BWT	r	0.070	−0.032	0.073	−0.050
	P	0.615	0.143	0.000	0.715		P	0.151	0.509	0.137	0.310
IPSS-v	r	0.095*	−0.033	0.028	−0.009	APD	r	0.009	0.003	0.011	0.012
	P	0.050	0.487	0.568	0.853		P	0.856	0.944	0.816	0.798
QoL	r	0.276**	−0.033	0.052	0.002	MCC	r	0.067	−0.016	0.042	0.050
	P	0.000	0.533	0.325	0.977		P	0.152	0.725	0.366	0.282
Age	r	−0.076	−0.045	−0.143**	−0.044	BS	r	0.121*	−0.015	0.045	0.024
	P	0.107	0.338	0.002	0.350		P	0.020	0.774	0.387	0.638
BMI	r	−0.019	−0.022	−0.010	−0.010	UIC	r	0.029	0.093	0.022	0.032
	P	0.730	0.685	0.861	0.854		P	0.608	0.099	0.691	0.577
Course of disease	r	−0.076	−0.043	−0.073	−0.107*	BC	r	0.131*	−0.037	0.096	−0.020
	P	0.109	0.367	0.128	0.025		P	0.019	0.512	0.085	0.714
Urinary retention	r	0.138*	0.061	0.030	0.075	DC	r	0.026	0.083	0.055	0.029
	P	0.015	0.277	0.597	0.184		P	0.629	0.126	0.316	0.596
Hematuria	r	0.062	−0.050	0.045	−0.090	BOO	r	0.047	0.099	0.073	0.017
	P	0.277	0.381	0.428	0.112		P	0.402	0.080	0.195	0.766
Dysuria	r	0.041	0.015	0.078	−0.057	Qmax	r	−0.039	−0.053	−0.052	−0.045
	P	0.469	0.794	0.167	0.314		P	0.419	0.275	0.277	0.353
PV	r	0.029	0.030	0.030	0.036	BOOI	r	0.025	0.094*	0.088	0.024
	P	0.528	0.514	0.523	0.436		P	0.599	0.045	0.060	0.605
Bladder stone	r	−0.042	−0.103	−0.062	−0.198**	URA	r	0.039	0.085	0.092*	0.022
	P	0.454	0.069	0.270	0.000		P	0.402	0.067	0.048	0.642
Type of surgery	r	0.070	0.045	−0.027	0.019
	P	0.214	0.431	0.639	0.732

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Supplementary Table 7.

Subgroup preoperative International Prostate Symptom Score and the influence of preoperative indicators on International Prostate Symptom Score improvement in patients with benign prostatic hyperplasia

	Preoperative IPSS			IPSS improvement

	Median (IQR)	Z	P	r	OR (95% CI)	P
Urinary retention (vs no)	21.00 (17.00–24.00)
Yes	22.00 (19.00–25.00)	−2.19	0.029	0.71	2.02 (0.67–6.08)	0.207
Hematuria (vs no)	21.00 (17.00–24.00)
Yes	22.00 (18.00–24.00)	−0.71	0.478	0.24	1.27 (0.49–3.30)	0.622
IPSS-s (vs severe)	25.00 (22.00–28.00)
Mild	14.00 (11.00–16.00)	−7.62	<0.001	−0.07	0.94 (0.18–4.89)	0.939
Moderate	19.00 (17.00–22.00)	−10.21	<0.001	−0.33	0.72 (0.32–1.63)	0.429
Mild vs moderate	-	−6.13	<0.001	0.27	1.31 (0.28–6.05)	0.733
IPSS-v (vs severe)	26.00 (23.00–28.00)
Mild	13.00 (11.00–16.00)	−8.20	<0.001	0.66	1.94 (0.55–6.81)	0.301
Moderate	20.00 (17.00–22.00)	−10.41	<0.001	1.11	3.02 (0.99–9.28)	0.053
Mild vs moderate	-	−7.29	<0.001	-	-	-
IPSS (vs severe)^#	23.00 (21.00–26.00)
Mild	6.00 (5.00–7.00)	-	-	-	-	-
Moderate	17.00 (14.00–18.00)	−14.69	<0.001	-	-	-
Mild vs moderate	-	-	-	-	-	-
QoL (vs ≤4)	17.00 (14.50–19.00)
5–6	22.00 (19.00–25.00)	−7.33	<0.001	0.48	1.61 (0.70–3.72)	0.261
PV (vs small)	21.00 (18.00–25.00)
Medium	21.00 (17.00–24.00)	−0.14	0.891	−0.04	0.96 (0.40–2.29)	0.921
Large	21.00 (17.00–24.00)	−1.45	0.146	1.74	5.69 (1.57–20.63)	0.008
Large vs medium	-	−1.05	0.293	0.66	1.93 (0.50–7.44)	0.339
APD (vs <4 cm)	21.00 (19.00–25.00)
≥4 cm	24.00 (21.00–27.00)	−1.98	0.048	0.26	1.29 (0.47–3.57)	0.620
BWT (vs ≤0.4 cm)	21.00 (18.00–23.00)
>0.4 cm	21.00 (17.00–25.00)	−1.07	0.283	−0.60	0.55 (0.19–1.60)	0.271
PVR (vs mild)	21.00 (17.00–24.00)
Moderate	22.00 (18.00–23.00)	−0.61	0.541	1.12	3.07 (0.67–14.07)	0.149
Severe	21.00 (17.00–24.00)	−0.28	0.777	−0.18	0.84 (0.34–2.04)	0.698
Severe vs moderate	-	−0.42	0.677	−1.30	0.27 (0.06–1.24)	0.093
Bladder stone (vs no)	21.00 (17.00–24.00)
Yes	22.00 (18.00–27.00)	−1.17	0.240	−0.15	0.86 (0.24–3.12)	0.817
Type of surgery (vs TURP)	21.00 (18.00–24.00)
PVP	21.00 (17.00–25.00)	−1.01	0.310	0.44	1.56 (0.65–3.75)	0.322
MCC (vs <200 ml)	21.00 (17.00–24.00)
≥200 ml	21.00 (19.00–25.00)	−1.71	0.087	−0.14	0.87 (0.34–2.26)	0.771
BS (vs reduced)	21.00 (17.00–23.00)
Sensitive	20.00 (17.00–24.00)	−0.64	0.525	0.08	1.08 (0.34–3.46)	0.893
Good	22.00 (18.00–24.75)	−2.09	0.037	1.10	3.11 (1.11–8.22)	0.031
Sensitive vs good	-	−1.33	0.164	−1.03	0.36 (0.13–0.98)	0.045
UIC (vs no)	21.00 (17.00–24.00)
Yes	21.00 (18.00–25.00)	−1.41	0.158	−0.53	0.59 (0.240–1.45)	0.249
BC (vs good)	24.00 (21.00–27.00)
Reduced	21.50 (18.75–25.00)	−1.35	0.177	0.26	1.30 (0.32–5.23)	0.717
DC (vs reduced)	21.00 (17.00–24.00)
Good	21.00 (18.00–24.00)	−1.03	0.303	1.73	5.66 (2.14–14.95)	0.001
BOO (vs no)^#	20.00 (13.00–22.00)
Suspicious	21.00 (17.00–24.00)	-	-	-	-	-
Yes	21.00 (18.00–24.00)	−0.05	0.960	-	-	-
Yes vs suspicious	-	-	-	-	-	-
Qmax (vs <10 ml/s)	21.00 (17.00–24.00)
≥10 ml/s	22.00 (16.75–23.75)	−0.04	0.968	0.13	1.14 (0.45–2.89)	0.783
BOOI (vs >40)	21.00 (17.00–25.00)
<20	21.00 (17.00–23.00)	−0.36	0.716	−1.08	0.34 (0.12–0.96)	0.041
20–40	21.00 (18.00–24.00)	−1.00	0.317	−1.22	0.30 (0.10–0.86)	0.026
20–40 vs <20	-	−1.14	0.255	−0.14	0.87 (0.31–2.47)	0.798
URA (vs <28.9884 cmH₂O)	20.00 (16.00–24.00)
≥28.9884 cmH₂O	21.00 (18.00–24.00)	−0.86	0.392	−0.82	0.44 (0.09–2.05)	0.295
≥28.9884 cmH₂O	12.00 (9.00–14.00)	−1.14	0.253	0.25	1.28 (0.17–9.55)	0.807

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^#Data may contain multicollinearity or complete separation: Which is not suitable for GEE analysis. APD: anterior posterior diameter of the prostate; BC: bladder compliance; BOO: bladder outlet obstruction; BOOI: BOO index; BS: bladder sensation; BWT: bladder wall thickness; DC: detrusor contractility; IPSS: International Prostate Symptom Score; IPSS-s: IPSS (storage); IPSS-v: IPSS (voiding); IQR: interquartile range; MCC: maximum cystometric capacity; PV: prostate volume; PVR: postvoid residual urine; Qmax: maximum flow rate; QoL: quality of life; UIC: uninhibited contraction; URA: urinary resistance factor; GEE: generalized estimating equation; CI: confidence interval; OR: odds ratio; TURP: transurethral resection of prostate; PVP: photoselective vaporization of the prostate

Supplementary Table 8.

Subgroup preoperative International Prostate Symptom Score (storage) and the influence of preoperative indicators on International Prostate Symptom Score (storage) improvement in patients with benign prostatic hyperplasia

	Preoperative IPSS-s			IPSS-s improvement

	Median (IQR)	Z	P	r	OR (95% CI)	P
Urinary retention (vs no)	10.00 (8.00–11.00)
Yes	10.00 (9.00–12.00)	−0.48	0.634	0.30	1.34 (0.71–2.55)	0.366
Hematuria (vs no)	10.00 (8.00–11.00)
Yes	10.00 (8.00–12.00)	−0.39	0.699	−0.38	0.69 (0.35–1.34)	0.269
IPSS-s (vs severe)	12.00 (11.00–13.00)
Mild	4.00 (3.00–5.00)	−8.00	<0.001	−0.80	0.45 (0.17–1.20)	0.109
Moderate	9.00 (8.00–10.00)	−14.59	<0.001	−0.56	0.57 (0.33–0.98)	0.042
Mild vs moderate	-	−8.26	<0.001	−0.08	0.92 (0.48–1.79)	0.814
IPSS-v (vs severe)	11.00 (9.00–13.00)
Mild	9.00 (6.00–11.00)	−3.04	0.002	0.06	1.06 (0.38–2.94)	0.910
Moderate	10.00 (8.00–10.00)	−3.81	<0.001	0.14	1.15 (0.45–2.92)	0.773
Mild vs moderate	-	−1.24	0.214	-	-	-
IPSS (vs severe)^#	11.00 (10.00–13.00)
Mild	2.00 (2.00–2.00)	-	-	-	-	-
Moderate	8.00 (6.00–10.00)	−10.26	<0.001	-	-	-
Mild vs moderate	-	-	-	-	-	-
QoL (vs ≤4)	9.00 (7.00–10.00)
5–6	10.00 (9.00–12.00)	−4.64	<0.001	0.43	1.54 (0.67–3.56)	0.312
PV (vs small)	10.00 (9.00–12.00)
Medium	10.00 (8.00–11.00)	−0.79	0.432	−0.01	0.99 (0.41–2.36)	0.979
Large	9.00 (7.00–11.00)	−1.14	0.257	1.73	5.67 (1.58–20.39)	0.008
Large vs medium	-	−1.70	0.090	0.74	2.09 (0.80–5.43)	0.130
APD (vs <4 cm)	10.00 (9.00–12.00)
≥4 cm	11.00 (10.00–13.00)	−2.35	0.019	0.28	1.32 (0.48–3.67)	0.589
BWT (vs ≤0.4 cm)	10.00 (8.00–11.00)
>0.4 cm	10.00 (8.00–12.00)	−0.23	0.815	0.14	1.15 (0.61–2.18)	0.667
PVR (vs mild)	10.00 (8.00–12.00)
Moderate	10.00 (8.00–12.00)	−0.39	0.697	0.43	1.54 (0.62–3.83)	0.354
Severe	10.00 (8.00–11.00)	−0.47	0.641	0.12	1.12 (0.61–2.07)	0.710
Severe vs moderate	-	−0.67	0.501	−0.32	0.73 (0.29–1.81)	0.497
Bladder stone (vs no)	10.00 (8.00–11.00)
Yes	10.00 (8.00–13.00)	−0.04	0.967	−0.02	0.99 (0.25–3.96)	0.983
Type of surgery (vs TURP)	10.00 (8.00–11.00)
PVP	10.00 (8.00–12.00)	−0.99	0.321	0.37	1.44 (0.61–3.42)	0.405
MCC (vs <200 ml)	10.00 (8.00–11.00)
≥200 ml	10.00 (9.00–12.00)	−2.31	0.021	0.29	1.33 (0.74–2.40)	0.340
BS (vs reduced)	9.00 (7.00–11.00)
Sensitive	10.00 (8.00–11.00)	−1.43	0.154	−0.53	0.59 (0.28–1.22)	0.155
Good	10.00 (9.00–12.00)	−2.19	0.028	0.63	1.88 (0.95–3.73)	0.071
Sensitive vs good	-	−0.64	0.524	−1.15	0.32 (0.16–0.62)	0.001
UIC (vs no)	10.00 (8.00–12.00)
Yes	10.00 (9.00–12.00)	−1.40	0.161	−0.63	0.53 (0.19–1.54)	0.245
BC (vs good)	11.00 (10.00–13.00)
Reduced	10.00 (9.00–12.00)	−0.98	0.328	−0.75	0.47 (0.23–0.98)	0.044
DC (vs reduced)	10.00 (8.00–12.00)
Good	10.00 (8.00–11.00)	−0.99	0.321	0.76	2.13 (1.17–3.90)	0.014
BOO (vs no)^#	10.50 (8.00–11.50)
Suspicious	10.00 (8.00–12.00)	-	-	-	-	-
Yes	10.00 (8.00–11.00)	-	-	-	-	-
Yes vs suspicious	-	−0.30	0.778	-	-	-
Qmax (vs <10 ml/s)	10.00 (8.00–12.00)
≥10 ml/s	10.00 (7.00–12.00)	−0.22	0.825	0.17	1.18 (0.47–2.99)	0.727
BOOI (vs >40)	10.00 (8.00–12.00)
<20	10.00 (8.00–11.00)	−0.34	0.737	−0.62	0.54 (0.28–1.05)	0.068
20–40	10.00 (8.00–12.00)	−0.96	0.336	−0.72	0.49 (0.23–1.02)	0.057
20–40 vs <20	-	−1.11	0.268	−0.10	0.91 (0.42–1.96)	0.802
URA (vs <28.9884 cmH₂O)	10.00 (7.50–12.00)
≥28.9884 cmH₂O	10.00 (8.00–11.00)	−0.12	0.908	−0.94	0.39 (0.07–2.04)	0.264
≥28.9884 cmH₂O	12.00 (9.00–14.00)	−1.14	0.253	0.25	1.28 (0.17–9.55)	0.807

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Supplementary Table 10.

Quality of life improvement in patients with benign prostatic hyperplasia at the postoperative 1^st, 6^th and 12^th months (vs preoperative)

	Preoperative QoL Median (IQR)	QoL at the postoperative 1^st month			QoL at the postoperative 6^th month			QoL at the postoperative 12^th month

		Median (IQR)	Z	P	Median (IQR)	Z	P	Median (IQR)	Z	P
Urinary retention (vs preoperative)
No	5.00 (4.00–5.00)	3.00 (2.00–4.00)	−12.34	<0.001	1.00 (1.00–3.00)	−12.73	<0.001	1.00 (1.00–3.00)	−11.29	<0.001
Yes	6.00 (5.00–6.00)	2.00 (1.00–3.00)	−8.11	<0.001	1.00 (1.00–2.00)	−8.21	<0.001	1.00 (1.00–3.00)	−7.20	<0.001
Hematuria (vs preoperative)
No	5.00 (5.00–6.00)	3.00 (1.00–3.00)	−12.48	<0.001	1.00 (1.00–3.00)	−12.86	<0.001	1.00 (1.00–3.00)	−10.92	<0.001
Yes	5.00 (5.00–6.00)	2.00 (3.00–3.00)	−7.90	<0.001	1.00 (1.00–3.00)	−7.99	<0.001	1.00 (1.00–3.00)	−7.75	<0.001
IPSS-s (vs preoperative)
Mild	5.00 (4.00–5.50)	3.00 (2.00–3.00)	−4.33	<0.001	2.00 (1.00–3.00)	−4.33	<0.001	1.00 (0–2.00)	−3.43	0.001
Moderate	5.00 (4.00–6.00)	3.00 (1.00–4.00)	−10.64	<0.001	1.00 (1.00–3.00)	−11.06	<0.001	1.00 (1.00–3.00)	−9.79	<0.001
Severe	5.00 (5.00–6.00)	3.00 (2.00–4.00)	−9.29	<0.001	1.00 (1.00–3.00)	−9.40	<0.001	1.00 (1.00–3.00)	−8.46	<0.001
IPSS-v (vs preoperative)
Mild	4.00 (4.00–5.00)	3.5 (2.00–4.00)	−4.25	<0.001	1.50 (0–3.00)	−4.76	<0.001	1.50 (0–3.00)	−4.44	<0.001
Moderate	5.00 (4.00–6.00)	3.00 (2.00–4.00)	−11.66	<0.001	1.00 (1.00–3.00)	−11.98	<0.001	1.00 (1.00–3.00)	−10.30	<0.001
Severe	6.00 (5.00–6.00)	2.00 (1.00–3.00)	−7.98	<0.001	1.00 (1.00–3.00)	−7.96	<0.001	2.00 (1.00–3.00)	−7.33	<0.001
IPSS (vs preoperative)
Mild	4.00 (3.00–4.00)	1.00 (0.50–1.00)	-	-	1.00 (1.00–1.00)	-	-	1.00 (1.00–1.00)	-	-
Moderate	5.00 (4.00–5.00)	3.00 (2.00–4.00)	−8.76	<0.001	2.00 (1.00–3.00)	−9.25	<0.001	1.00 (1.00–3.00)	−7.85	<0.001
Severe	5.00 (5.00–6.00)	3.00 (1.00–3.00)	−11.82	<0.001	1.00 (1.00–3.00)	−11.91	<0.001	1.00 (1.00–3.00)	−10.74	<0.001
QoL (vs preoperative)
Good	4.00 (4.00–4.00)	3.00 (2.00–4)	−5.87	<0.001	2.00 (0–3.00)	−6.80	<0.001	1.00 (0.50–2.00)	−5.67	<0.001
Poor	5.00 (5.00–6.00)	3.00 (1.00–3)	−13.42	<0.001	1.00 (1.00–3.00)	−13.53	<0.001	1.00 (1.00–3.00)	−12.12	<0.001
PV (vs preoperative)
Small	5.00 (5.00–6.00)	3.00 (2.00–3.00)	−9.18	<0.001	1.00 (1.00–3.00)	−9.62	<0.001	1.00 (1.00–3.00)	−8.68	<0.001
Medium	5.00 (5.00–6.00)	3.00 (1.00–4.00)	−10.03	<0.001	2.00 (1.00–3.00)	−10.10	<0.001	1.00 (1.00–3.00)	−8.90	<0.001
Large	5.00 (5.00–6.00)	2.00 (1.00–3.75)	−5.80	<0.001	1.00 (1.00–2.00)	−5.89	<0.001	1.50 (1.00–3.00)	−4.97	<0.001
APD (vs preoperative)
<4 cm	5.00 (5.00–6.00)	3.00 (1.00–3.00)	−7.85	<0.001	1.00 (1.00–3.00)	−8.14	<0.001	1.00 (0–3.00)	−7.10	<0.001
≥4 cm	6.00 (5.00–6.00)	3.00 (1.00–3.00)	−12.51	<0.001	1.00 (1.00–3.00)	−12.76	<0.001	1.00 (1.00–3.00)	−11.34	<0.001
BWT (vs preoperative)
≤0.4 cm	5.00 (5.00–5.50)	3.00 (2.00–3.00)	−8.31	<0.001	2.00 (1.00–3.00)	−8.30	<0.001	1.00 (1.00–3.00)	−7.21	<0.001
>0.4 cm	5.00 (5.00–6.00)	3.00 (1.00–4.00)	−12.22	<0.001	1.00 (1.00–3.00)	−12.66	<0.001	1.00 (1.00–3.00)	−11.28	<0.001
PVR (vs preoperative)
<50 ml	5.00 (5.00–6.00)	3.00 (2.00–4.00)	−10.07	<0.001	1.00 (1.00–3.00)	−10.41	<0.001	1.00 (0–3.00)	−9.48	<0.001
Moderate	5.00 (5.00–6.00)	2.50 (2.00–3.00)	−5.68	<0.001	1.00 (0.25–2.00)	−5.75	<0.001	1.00 (0.25–2.75)	−4.89	<0.001
Severe	5.00 (5.00–6.00)	2.00 (1.00–3.00)	−9.21	<0.001	2.00 (1.00–3.00)	−9.40	<0.001	2.00 (1.00–3.00)	−8.11	<0.001
Bladder stone (vs preoperative)
No	5.00 (5.00–6.00)	3.00 (1.00–3.00)	−14.09	<0.001	1.00 (1.00–3.00)	−14.47	<0.001	1.00 (1.00–3.00)	−12.70	<0.001
Yes	5.00 (5.00–6.00)	3.00 (2.00–3.00)	−4.46	<0.001	1.00 (0–3.00)	−4.45	<0.001	1.00 (0–2.75)	−4.22	<0.001
Type of surgery (vs preoperative)
TURP	5.00 (5.00–6.00)	3.00 (2.00–4.00)	−12.77	<0.001	1.00 (1.00–3.00)	−13.14	<0.001	1.00 (1.00–3.00)	−11.47	<0.001
PVP	5.00 (5.00–6.00)	3.00 (1.00–3.00)	−7.44	<0.001	1.00 (1.00–2.00)	−7.52	<0.001	1.00 (1.00–3.00)	−6.89	<0.001
MCC (vs preoperative)
<200 ml	5.00 (5.00–6.00)	2.50 (1.00–3.00)	−12.05	<0.001	1.00 (1.00–2.00)	−12.41	<0.001	1.00 (1.00–3.00)	−10.58	<0.001
≥200 ml	5.00 (5.00–6.00)	3.00 (2.00–3.00)	−8.54	<0.001	1.00 (1.00–3.00)	−8.67	<0.001	1.00 (0–3.00)	−8.21	<0.001
BS (vs preoperative)
Reduced	5.00 (4.00–6.00)	2.00 (1.00–3.00)	−7.18	<0.001	2.00 (1.00–2.00)	−7.25	<0.001	1.00 (1.00–3.00)	−5.46	<0.001
Sensitive	5.00 (4.00–5.00)	3.00 (2.00–4.00)	−10.91	<0.001	2.00 (1.00–3.00)	−11.28	<0.001	2.00 (1.00–3.00)	−10.38	<0.001
Good	5.00 (5.00–6.00)	3.00 (1.00–3.00)	−6.91	<0.001	1.00 (1.00–3.00)	−7.04	<0.001	1.00 (1.00–3.00)	−6.49	<0.001
UIC (vs preoperative)
No	5.00 (5.00–6.00)	3.00 (1.00–4.00)	−12.55	<0.001	2.00 (1.00–3.00)	−12.83	<0.001	1.00 (1.00–3.00)	−11.33	<0.001
Yes	5.00 (4.00–6.00)	3.00 (2.00–3.00)	−7.80	<0.001	1.00 (1.00–3.00)	−8.04	<0.001	1.00 (0.50–3.00)	−7.13	<0.001
BC (vs preoperative)
Reduced	5.00 (5.00–6.00)	3.00 (2.00–4.00)	−5.27	<0.001	3.00 (1.00–3.00)	−5.49	<0.001	2.00 (1.00–4.00)	−4.67	<0.001
Good	6.00 (5.00–6.00)	3.00 (1.00–3.25)	−13.80	<0.001	1.00 (1.00–3.00)	−14.11	<0.001	1.00 (1.00–3.00)	−12.54	<0.001
DC (vs preoperative)
Reduced	5.00 (5.00–6.00)	3.00 (2.00–4.00)	−10.34	<0.001	2.00 (1.00–3.00)	−10.63	<0.001	1.00 (1.00–3.00)	−9.43	<0.001
Good	5.00 (5.00–6.00)	3.00 (1.00–3.00)	−10.54	<0.001	1.00 (1.00–3.00)	−10.78	<0.001	1.00 (1.00–2.00)	−9.49	<0.001
BOO (vs preoperative)
No	4.50 (4.00–5.00)	3.00 (2.25–3.25)	-	-	1.50 (0–2. 25)	-	-	1.50 (0–2.25)	-	-
Suspicious	5.00 (5.00–6.00)	3.00 (1.00–4.00)	−9.79	<0.001	1.00 (1.00–3.00)	−9.97	<0.001	1.50 (1.00–3.00)	−8.66	<0.001
Yes	5.00 (5.00–6.00)	3.00 (1.00–3.00)	−10.99	<0.001	1.00 (1.00–3.00)	−11.32	<0.001	1.00 (1.00–3.00)	−10.14	<0.001
Qmax (vs preoperative)
<10 ml/s	5.00 (5.00–6.00)	3.00 (1.00–3.00)	−14.33	<0.001	1.00 (1.00–3.00)	−14.74	<0.001	1.00 (1.00–3.00)	−12.97	<0.001
≥10 ml/s	5.00 (5.00–6.00)	3.00 (2.00–4.00)	−3.59	<0.001	1.00 (1.00–2.75)	−3.44	0.001	1.00 (1.00–3.00)	−3.32	0.001
BOOI (vs preoperative)
<20	5.00 (5.00–6.00)	3.00 (2.00–4.00)	−7.66	<0.001	2.00 (1.00–3.00)	−7.99	<0.001	2.00 (1.00–3.00)	−6.77	<0.001
20–40	5.00 (5.00–6.00)	2.00 (1.00–3.25)	−6.44	<0.001	1.00 (0.75–3.00)	−6.49	<0.001	1.00 (0–3.00)	−6.04	<0.001
>40	5.00 (4.25–6.00)	3.00 (1.00–3)	−10.88	<0.001	1.50 (1.00–3.00)	−11.11	<0.001	1.00 (1.00–3.00)	−9.88	<0.001
URA (vs preoperative)
<28.9884 cmH₂O	5.00 (4.00–6.00)	3.00 (1.00–4.00)	−9.25	<0.001	1.00 (1.00–3.00)	−9.42	<0.001	1.00 (1.00–3.00)	−8.20	<0.001
≥28.9884 cmH₂O	5.00 (5.00–6.00)	3.00 (1.00–3.00)	−11.52	<0.001	1.00 (1.00–3.00)	−11.84	<0.001	1.00 (1.00–3.00)	−10.58	<0.001

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APD: anterior posterior diameter of the prostate; BC: bladder compliance; BOO: bladder outlet obstruction; BOOI: BOO index; BS: bladder sensation; BWT: bladder wall thickness; DC: detrusor contractility; IPSS: International Prostate Symptom Score; IPSS-s: IPSS (storage); IPSS-v: IPSS (voiding); IQR: interquartile range; MCC: maximum cystometric capacity; PV: prostate volume; PVR: postvoid residual urine; Qmax: maximum flow rate; QoL: quality of life; UIC: uninhibited contraction; URA: urinary resistance factor; TURP: transurethral resection of prostate; PVP: photoselective vaporization of the prostate

Supplementary Table 11.

International Prostate Symptom Score improvement in patients with benign prostatic hyperplasia at the postoperative 1^st, 6^th and 12^th months (vs preoperative)

	Preoperative IPSS, median (IQR)	IPSS at the postoperative 1^st month			IPSS at the postoperative 6^th month			IPSS at the postoperative 12^th month

		Median (IQR)	Z	P	Median (IQR)	Z	P	Median (IQR)	Z	P
Urinary retention (vs preoperative)
No	21.00 (17.00–24.00)	3.00 (2.00–5.00)	−12.95	<0.001	2.00 (1.00–5.00)	−12.92	<0.001	2.00 (1.00–5.00)	−11.44	<0.001
Yes	22.00 (19.00–25.00)	3.00 (2.00–5.00)	−8.24	<0.001	2.00 (1.00–5.00)	−8.24	<0.001	2. 50 (1.00–5.00)	−7.28	<0.001
Hematuria (vs preoperative)
No	21.00 (17.00–24.00)	3.00 (2.00–5.00)	−13.04	<0.001	2.00 (1.00–5.00)	−13.01	<0.001	2.00 (1.00–5.00)	−11.11	<0.001
Yes	22.00 (18.00–24.00)	3.00 (2.00–5.00)	−8.10	<0.001	2.00 (1.00–5.00)	−8.10	<0.001	2.00 (1.00–5.00)	−7.76	<0.001
IPSS-s (vs preoperative)
Mild	14.00 (11.00–16.00)	2.00 (1.00–6.00)	−4.38	<0.001	2.00 (1.00–4.00)	−4.38	<0.001	2.00 (1.00–3.00)	−3.42	0.001
Moderate	19.00 (17.00–22.00)	3.00 (1.50–5.00)	−11.28	<0.001	2.00 (1.00–5.00)	−11.25	<0.001	2.00 (1.00–5.00)	−9.93	<0.001
Severe	25.00 (22.00–28.00)	4.00 (2.00–5.00)	−9.47	<0.001	3.00 (2.00–5.00)	−9.47	<0.001	3.00 (2.00–5.50)	−8.56	<0.001
IPSS-v (vs preoperative)
Mild	13.00 (11.00–16.00)	2.50 (1.00–7.25)	−4.87	<0.001	2.00 (1.00–5.00)	−4.87	<0.001	2.00 (1.00–7.00)	−4.43	<0.001
Moderate	20.00 (17.00–22.00)	3.00 (2.00–5.00)	−12.18	<0.001	2.00 (1.00–5.00)	−12.18	<0.001	2.00 (1.00–4.00)	−10.49	<0.001
Severe	26.00 (23.00–28.00)	4.00 (2.00–5.00)	−8.01	<0.001	3.00 (2.00–5.00)	−7.96	<0.001	3.00 (2.00–6.00)	−7.33	<0.001
IPSS (vs preoperative)
Mild	6.00 (5.00–7.00)	1.00 (0.50–1.00)	-	-	1.00 (1.00–1.00)	-	-	1.00 (1.00–1.00)	-	-
Moderate	17.00 (14.00–18.00)	4.00 (2.00–6.00)	−9.43	<0.001	2.00 (1.00–5.00)	−9.44	<0.001	2.00 (1.00–5.00)	−8.01	<0.001
Severe	23.00 (21.00–26.00)	3.00 (2.00–5.00)	−12.03	<0.001	2.00 (1.00–5.00)	−12.00	<0.001	3.00 (1.00–5.00)	−10.81	<0.001
QoL (vs preoperative)
Good	17.00 (14.50–19.00)	3.00 (2.00–6.00)	−7.22	<0.001	2.00 (1.00–5.00)	−7.23	<0.001	2.00 (1.00–5.50)	−6.06	<0.001
Poor	22.00 (19.00–25.00)	3.00 (2.00–5.00)	−13.55	<0.001	2.00 (1.00–5.00)	−13.52	<0.001	2.50 (1.00–5.00)	−12.08	<0.001
PV (vs preoperative)
Small	21.00 (18.00–25.00)	4.00 (2.00–5.00)	−9.71	<0.001	3.00 (1.00–5.00)	−9.67	<0.001	2.00 (1.00–5.00)	−8.77	<0.001
Medium	21.00 (17.00–24.00)	3.00 (2.00–5.00)	−10.34	<0.001	2.00 (1.00–5.00)	−10.34	<0.001	2.50 (1.00–6.00)	−9.09	<0.001
Large	21.00 (17.00–24.00)	3.00 (2.00–4.00)	−5.90	<0.001	2.00 (1.00–4.75)	−5.90	<0.001	2.00 (1.00–5.00)	−4.87	<0.001
APD (vs preoperative)
<4 cm	21.00 (19.00–25.00)	4.00 (2.00–6.00)	−8.24	<0.001	3.00 (1.00–5.00)	−8.20	<0.001	3.00 (1.75–5.00)	−7.22	<0.001
≥4 cm	24.00 (21.00–27.00)	3.00 (2.00–5.00)	−12.95	<0.001	2.00 (1.00–4.00)	−12.95	<0.001	2.00 (1.00–5.00)	−11.44	<0.001
BWT (vs preoperative)
≤0.4 cm	21.00 (18.00–23.00)	3.50 (2.00–5.00)	−8.38	<0.001	3.00 (2.00–5.00)	−8.38	<0.001	3.00 (2.00–6.00)	−7.33	<0.001
>0.4 cm	21.00 (17.00–25.00)	3.00 (2.00–5.00)	−12.86	<0.001	2.00 (1.00–5.00)	−12.84	<0.001	2.00 (1.00–5.00)	−11.37	<0.001
PVR (vs preoperative)
<50 ml	21.00 (17.00–24.00)	3.00 (2.00–5.00)	−10.52	<0.001	2.00 (1.00–5.00)	−10.52	<0.001	2.00 (1.00–5.00)	−9.58	<0.001
Moderate	22.00 (18.00–23.00)	3.00 (2.00–5.00)	−5.78	<0.001	2.00 (1.00–4.00)	−5.79	<0.001	2.00 (1.25–5.00)	−4.94	<0.001
Severe	21.00 (17.00–24.00)	3.00 (2.00–5.00)	−9.59	<0.001	2.00 (1.00–5.00)	−9.55	<0.001	3.00 (1.00–5.25)	−8.20	<0.001
Bladder stone (vs preoperative)
No	21.00 (17.00–24.00)	3.00 (2.00–5.00)	−14.64	<0.001	2.00 (1.00–5.00)	−14.61	<0.001	2.00 (1.00–5.00)	−12.83	<0.001
Yes	22.00 (18.00–27.00)	4.00 (2.00–6.00)	−4.63	<0.001	2.50 (1.00–6.25)	−4.60	<0.001	2.00 (1.00–5.00)	−4.26	<0.001
Type of surgery (vs preoperative)
TURP	21.00 (18.00–24.00)	3.00 (2.00–5.00)	−13.32	<0.001	2.00 (1.00–5.00)	−13.32	<0.001	2.00 (1.00–5.00)	−11.64	<0.001
PVP	21.00 (17.00–25.00)	3.00 (2.00–5.00)	−7.63	<0.001	2.00 (1.00–4.50)	−7.58	<0.001	2.00 (1.00–5.00)	−6.90	<0.001
MCC (vs preoperative)
<200 ml	21.00 (17.00–24.00)	3.00 (2.00–5.00)	−12.51	<0.001	2.00 (1.00–4.00)	−12.48	<0.001	2.00 (1.00–5.00)	−10.59	<0.001
≥200 ml	21.00 (19.00–25.00)	3.00 (2.00–5.00)	−8.90	<0.001	3.00 (1.00–5.00)	−8.90	<0.001	3.00 (1.00–6.00)	−8.42	<0.001
BS (vs preoperative)
Reduced	21.00 (17.00–23.00)	3.00 (1.00–5.00)	−7.37	<0.001	2.00 (1.00–4.00)	−7.33	<0.001	3.00 (1.00–6.00)	−5.50	<0.001
Sensitive	20.00 (17.00–24.00)	4.00 (2.00–6.00)	−11.28	<0.001	3.00 (1.25–5.00)	−11.28	<0.001	3.00 (2.00–7.00)	−10.34	<0.001
Good	22.00 (18.00–24.75)	3.00 (2.00–5.00)	−7.38	<0.001	2.00 (1.00–4.00)	−7.38	<0.001	2.00 (1.00–4.50)	−6.78	<0.001
UIC (vs preoperative)
No	21.00 (17.00–24.00)	3.00 (2.00–5.00)	−13.04	<0.001	2.00 (1.00–5.00)	−13.01	<0.001	2.00 (1.00–5.00)	−11.44	<0.001
Yes	21.00 (18.00–25.00)	3.00 (2.00–5.00)	−8.10	<0.001	3.00 (1.00–5.00)	−8.11	<0.001	3.00 (1.00–5.00)	−7.22	<0.001
BC (vs preoperative)
Reduced	21.50 (18.75–25.00)	4.00 (2.00–6.00)	−5.65	<0.001	5.00 (2.00–6.00)	−5.65	<0.001	4.00 (2.00–7.00)	−4.84	<0.001
Good	24.00 (21.00–27.00)	3.00 (2.00–5.00)	−14.27	<0.001	2.00 (1.00–4.25)	−14.25	<0.001	2.00 (1.00–5.00)	−12.63	<0.001
DC (vs preoperative)
Reduced	21.00 (17.00–24.00)	4.00 (2.00–6.00)	−10.63	<0.001	3.00 (2.00–5.00)	−10.63	<0.001	3.00 (1.00–6.75)	−9.35	<0.001
Good	21.00 (18.00–24.00)	3.00 (1.00–4.00)	−11.08	<0.001	2.00 (1.00–4.00)	−11.04	<0.001	2.00 (1.00–4.00)	−9.77	<0.001
BOO (vs preoperative)
No	20.00 (13.00–22.00)	2.50 (0.75–3.00)	-	-	4.50 (0.75–6.00)	-	-	4.50 (0.75–6.00)	-	-
Suspicious	21.00 (17.00–24.00)	4.00 (2.00–6.00)	−10.23	<0.001	2.00 (1.00–5.00)	−10.20	<0.001	2.00 (1.00–6.00)	−8.89	<0.001
Yes	21.00 (18.00–24.00)	3.00 (2.00–5.00)	−11.38	<0.001	2.00 (1.00–4.00)	−11.38	<0.001	2.00 (1.00–4.00)	−10.12	<0.001
Qmax (vs preoperative)
<10 ml/s	21.00 (17.00–24.00)	3.00 (2.00–5.00)	−14.94	<0.001	2.00 (1.00–5.00)	−14.92	<0.001	2.00 (1.00–5.00)	−13.09	<0.001
≥10 ml/s	22.00 (16.75–23.75)	3.50 (1.00–4.75)	−3.52	<0.001	2.00 (1.00–3.00)	−3.52	<0.001	2.00 (1.00–5.00)	−3.41	0.001
BOOI (vs preoperative)
<20	21.00 (17.00–23.00)	4.00 (2.00–6.00)	−8.15	<0.001	2.00 (1.00–5.00)	−8.11	<0.001	3.00 (1.00–7.00)	−6.96	<0.001
20–40	21.00 (18.00–24.00)	3.50 (1.00–6.25)	−6.67	<0.001	3.00 (1.00–5.25)	−6.69	<0.001	2.00 (1.00–6.00)	−6.14	<0.001
>40	21.00 (17.25–25.00)	3.00 (2.00–4.00)	−11.18	<0.001	2.00 (1.00–4.25)	−11.18	<0.001	2.00 (1.00–4.00)	−9.86	<0.001
URA (vs preoperative)
<28.9884 cmH₂O	20.00 (16.00–24.00)	4.00 (2.00–5.50)	−9.71	<0.001	2.00 (1.00–5.00)	−9.67	<0.001	3.00 (1.00–6.75)	−8.46	<0.001
≥28.9884 cmH₂O	21.00 (18.00–24.00)	3.00 (2.00–5.00)	−11.89	<0.001	2.00 (1.00–4.00)	−11.90	<0.001	2.00 (1.00–4.75)	−10.56	<0.001

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APD: anterior posterior diameter of the prostate; BC: bladder compliance; BOO: bladder outlet obstruction; BOOI: BOO index; BS: bladder sensation; BWT: bladder wall thickness; DC: detrusor contractility; IPSS: International Prostate Symptom Score; IPSS-s: IPSS (storage); IPSS-v: IPSS (voiding); IQR: interquartile range; MCC: maximum cystometric capacity; PV: prostate volume; PVR: postvoid residual urine; Qmax: maximum flow rate; QoL: quality of life; UIC: uninhibited contraction; URA: urinary resistance factor; TURP: transurethral resection of prostate; PVP: photoselective vaporization of the prostate

Supplementary Table 12.

International Prostate Symptom Score (storage) improvement in patients with benign prostatic hyperplasia at the postoperative 1^st, 6^th and 12^th months (vs preoperative)

	Preoperative IPSS-s, median (IQR)	IPSS-s at the postoperative 1^st month			IPSS-s at the postoperative 6^th month			IPSS-s at the postoperative 12^th month

		Median (IQR)	Z	P	Median (IQR)	P	P	Median (IQR)	P	P
Urinary retention (vs preoperative)
No	10.00 (8.00–11.00)	3.00 (2.00–4.00)	−12.67	<0.001	2.00 (1.00–4.00)	−12.73	<0.001	2.00 (1.00–4.00)	−11.19	<0.001
Yes	10.00 (9.00–12.00)	3.00 (2.00–4.00)	−8.05	<0.001	2.00 (1.00–4.00)	−8.11	<0.001	2.00 (1.00–4.00)	−7.26	<0.001
Hematuria (vs preoperative)
No	10.00 (8.00–11.00)	3.00 (2.00–4.00)	−7.97	<0.001	2.00 (1.00–4.00)	−8.07	<0.001	2.00 (1.00–4.00)	−7.72	<0.001
Yes	10.00 (8.00–12.00)	2.00 (1.00–4.00)	−7.97	<0.001	2.00 (1.00–4.00)	−8.07	<0.001	2.00 (1.00–4.00)	−7.72	<0.001
IPSS-s (vs preoperative)
Mild	4.00 (3.00–5.00)	2.00 (1.00–5.00)	−1.61	0.108	2.00 (1.00–3.00)	−2.77	0.006	2.00 (1.00–3.00)	−2.67	0.008
Moderate	9.00 (8.00–10.00)	2.00 (1.00–4.00)	−11.17	<0.001	2.00 (1.00–4.00)	−11.21	<0.001	2.00 (1.00–4.00)	−9.83	<0.001
Severe	12.00 (11.00–13.00)	3.00 (2.00–4.00)	−9.50	<0.001	3.00 (2.00–4.00)	−9.47	<0.001	2.00 (1.00–4.00)	−8.58	<0.001
IPSS-v (vs preoperative)
Mild	9.00 (6.00–11.00)	2.00 (1.00–5.00)	−4.63	<0.001	2.00 (1.00–3.25)	−4.87	<0.001	2.00 (1.00–4.25)	−4.38	<0.001
Moderate	10.00 (8.00–10.00)	2.00 (1.00–4.00)	−11.91	<0.001	2.00 (1.00–3.00)	−11.97	<0.001	2.00 (1.00–3.00)	−10.35	<0.001
Severe	11.00 (9.00–13.00)	3.00 (2.00–4.00)	−7.94	<0.001	3.00 (2.00–4.00)	−7.88	<0.001	2.00 (2.00–4.75)	−7.21	<0.001
IPSS (vs preoperative)
Mild	2.00 (2.00–2.00)	1.00 (1.00–1.00)	-	-	1.00 (1.00–1.00)	-	-	1.00 (1.00–1.00)	-	-
Moderate	8.00 (6.00–10.00)	3.00 (1.50–4.50)	−8.73	<0.001	2.00 (1.00–4.00)	−9.06	<0.001	2.00 (1.00–4.00)	−7.76	<0.001
Severe	11.00 (10.00–13.00)	3.00 (2.00–4.00)	−12.01	<0.001	2.00 (1.00–4.00)	−11.94	<0.001	2.00 (1.00–4.00)	−10.80	<0.001
QoL (vs preoperative)
Good	9.00 (7.00–10.00)	3.00 (2.00–5.00)	−7.05	<0.001	2.00 (1.00–4.50)	−7.16	<0.001	2.00 (1.00–4.00)	−5.92	<0.001
Poor	10.00 (9.00–12.00)	3.00 (2.00–4.00)	−13.31	<0.001	2.00 (1.00–4.00)	−13.33	<0.001	2.00 (1.00–4.00)	−12.00	<0.001
PV (vs preoperative)
Small	10.00 (9.00–12.00)	3.00 (2.00–4.00)	−9.47	<0.001	2.00 (1.00–4.00)	−9.46	<0.001	2.00 (1.00–4.00)	−8.64	<0.001
Medium	10.00 (8.00–11.00)	2.00 (1.00–4.00)	−10.15	<0.001	2.00 (1.00–4.00)	−10.23	<0.001	2.00 (1.00–4.00)	−8.91	<0.001
Large	9.00 (7.00–11.00)	2.00 (2.00–4.00)	−5.79	<0.001	2.00 (1.00–3.00)	−5.92	<0.001	2.00 (1.00–3.75)	−4.95	<0.001
APD (vs preoperative)
<4 cm	10.00 (9.00–12.00)	3.00 (2.00–5.00)	−8.14	<0.001	2.00 (1.00–4.00)	−8.06	<0.001	2.00 (1.00–4.00)	−7.11	<0.001
≥4 cm	11.00 (10.00–13.00)	2.00 (2.00–4.00)	−12.64	<0.001	2.00 (1.00–3.00)	−12.79	<0.001	2.00 (1.00–4.00)	−11.32	<0.001
BWT (vs preoperative)
≤0.4 cm	10.00 (8.00–11.00)	3.00 (2.00–4.00)	−8.21	<0.001	2.00 (1.00–4.00)	−8.19	<0.001	2.00 (1.25–4.00)	−7.33	<0.001
>0.4 cm	10.00 (8.00–12.00)	2.00 (1.50–4.00)	−12.60	<0.001	2.00 (1.00–4.00)	−12.72	<0.001	2.00 (1.00–3.50)	−11.18	<0.001
PVR (vs preoperative)
<50 ml	10.00 (8.00–12.00)	3.00 (2.00–4.00)	−10.40	<0.001	2.00 (1.00–4.00)	−10.46	<0.001	2.00 (1.00–4.00)	−9.42	<0.001
Moderate	11.00 (8.00–12.00)	2.50 (2.00–4.00)	−5.76	<0.001	2.00 (1.00–3.00)	−5.66	<0.001	2.00 (1.00–4.00)	−4.83	<0.001
Severe	10.00 (8.00–11.00)	3.00 (2.00–4.00)	−9.22	<0.001	2.00 (1.00–4.00)	−9.36	<0.001	2.00 (1.00–4.00)	−8.17	<0.001
Bladder stone (vs preoperative)
No	10.00 (8.00–11.00)	3.00 (2.00–4.00)	−14.33	<0.001	2.00 (1.00–4.00)	−14.40	<0.001	2.00 (1.00–4.00)	−12.66	<0.001
Yes	10.00 (8.00–13.00)	3.00 (2.00–4.00)	−4.55	<0.001	2.00 (1.00–4.00)	−4.63	<0.001	2.00 (1.00–3.00)	−4.25	<0.001
Type of surgery (vs preoperative)
TURP	10.00 (8.00–11.00)	3.00 (2.00–4.00)	−13.01	<0.001	2.00 (1.00–4.00)	−13.15	<0.001	2.00 (1.00–4.00)	−11.48	<0.001
PVP	10.00 (8.00–12.00)	3.00 (2.00–4.00)	−7.53	<0.001	2.00 (1.00–4.00)	−7.47	<0.001	2.00 (1.00–4.00)	−6.84	<0.001
MCC (vs preoperative)
<200 ml	10.00 (8.00–11.00)	3.00 (2.00–4.00)	−12.15	<0.001	2.00 (1.00–3.00)	−12.29	<0.001	2.00 (1.00–4.00)	−10.46	<0.001
≥200 ml	10.00 (9.00–12.00)	3.00 (2.00–4.50)	−8.86	<0.001	2.00 (1.00–4.00)	−8.81	<0.001	2.00 (1.00–4.00)	−8.32	<0.001
BS (vs preoperative)
Reduced	9.00 (7.00–11.00)	2.00 (1.00–4.00)	−6.92	<0.001	2.00 (1.00–4.50)	−7.06	<0.001	2.00 (1.00–4.00)	−5.46	<0.001
Sensitive	10.00 (8.00–11.00)	3.00 (2.00–5.00)	−11.21	<0.001	3.00 (1.00–5.00)	−11.22	<0.001	3.00 (2.00–5.00)	−10.27	<0.001
Good	10.00 (9.00–12.00)	3.00 (2.00–4.00)	−7.18	<0.001	2.00 (1.00–3.00)	−7.23	<0.001	2.00 (1.00–3.00)	−6.56	<0.001
UIC (vs preoperative)
No	10.00 (8.00–12.00)	2.50 (2.00–4.00)	−12.70	<0.001	2.00 (1.00–4.00)	−12.76	<0.001	2.00 (1.00–4.00)	−11.28	<0.001
Yes	10.00 (9.00–12.00)	3.00 (2.00–4.00)	−8.03	<0.001	2.00 (1.00–4.00)	−8.11	<0.001	2.00 (1.00–4.00)	−7.17	<0.001
BC (vs preoperative)
Reduced	10.00 (9.00–12.00)	3.00 (2.00–6.00)	−5.65	<0.001	4.00 (2.00–5.00)	−5.59	<0.001	3.00 (2.00–6.00)	−4.63	<0.001
Good	11.00 (10.00–13.00)	2.50 (2.00–4.00)	−13.93	<0.001	2.00 (1.00–3.00)	−14.05	<0.001	2.00 (1.00–3.25)	−12.54	<0.001
DC (vs preoperative)
Reduced	10.00 (8.00–12.00)	3.00 (2.00–4.00)	−10.50	<0.001	2.00 (1.00–4.00)	−10.55	<0.001	2.00 (1.00–5.00)	−9.32	<0.001
Good	10.00 (8.00–11.00)	2.00 (1.00–4.00)	−10.77	<0.001	2.00 (1.00–3.00)	−10.82	<0.001	2.00 (1.00–3.00)	−9.56	<0.001
BOO (vs preoperative)
No	10.50 (8.00–11.50)	2.00 (0.75–2.25)	-	-	2.50 (0.75–3.00)	-	-	2.50 (0.75–3.00)	-	-
Suspicious	10.00 (8.00–12.00)	3.00 (2.00–5.00)	−10.01	<0.001	2.00 (1.00–4.00)	−9.98	<0.001	2.00 (1.00–4.25)	−8.80	<0.001
Yes	10.00 (8.00–11.00)	3.00 (2.00–4.00)	−11.16	<0.001	2.00 (1.00–3.00)	−11.29	<0.001	2.00 (1.00–3.00)	−9.99	<0.001
Qmax (vs preoperative)
<10 ml/s	10.00 (8.00–12.00)	3.00 (2.00–4.00)	−14.62	<0.001	2.00 (1.00–4.00)	−14.73	<0.001	2.00 (1.00–4.00)	−12.92	<0.001
≥10 ml/s	10.00 (7.00–12.00)	2.00 (1.00–4.00)	−3.47	0.001	2.00 (1.00–3.00)	−3.42	0.001	1.00 (1.00–3.00)	−3.41	0.001
BOOI (vs preoperative)
<20	10.00 (8.00–11.00)	3.00 (2.00–4.50)	−7.95	<0.001	2.00 (1.00–4.00)	−7.99	<0.001	2.00 (1.00–4.00)	−6.84	<0.001
20–40	10.00 (8.00–12.00)	3.00 (1.00–5.00)	−6.36	<0.001	2.50 (1.00–5.00)	−6.42	<0.001	2.00 (1.00–5.00)	−5.99	<0.001
>40	10.00 (8.00–12.00)	2.00 (2.00–4.00)	−11.11	<0.001	2.00 (1.00–3.00)	−11.14	<0.001	2.00 (1.00–3.00)	−9.81	<0.001
URA (vs preoperative)
<28.9884 cmH₂O	10.00 (7.50–12.00)	3.00 (2.00–5.00)	−9.29	<0.001	2.00 (1.00–4.00)	−9.38	<0.001	2.00 (1.00–4.00)	−8.29	<0.001
≥28.9884 cmH₂O	10.00 (8.00–11.00)	3.00 (2.00–4.00)	−11.80	<0.001	2.00 (1.00–3.00)	−11.86	<0.001	2.00 (1.00–3.50)	−10.48	<0.001

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APD: anterior posterior diameter of the prostate; BC: bladder compliance; BOO: bladder outlet obstruction; BOOI: BOO index; BS: bladder sensation; BWT: bladder wall thickness; DC: detrusor contractility; IPSS: International Prostate Symptom Score; IPSS-s: IPSS (storage); IPSS-v: IPSS (voiding); IQR: interquartile range; MCC: maximum cystometric capacity; PV: prostate volume; PVR: postvoid residual urine; Qmax: maximum flow rate; QoL: quality of life; UIC: uninhibited contraction; URA: urinary resistance factor; TURP: transurethral resection of prostate; PVP: photoselective vaporization of the prostate

Supplementary Table 13.

International Prostate Symptom Score (voiding) improvement in patients with benign prostatic hyperplasia at the postoperative 1^st, 6^th and 12^th months (vs preoperative)

	Preoperative IPSS-v, median (IQR)	IPSS-v at the postoperative 1^st month			IPSS-v at the postoperative 6^th month			IPSS-v at the postoperative 12^th month

		Median (IQR)	Z	P	Median (IQR)	Z	P	Median (IQR)	Z	P
Urinary retention (vs preoperative)
No	11.00 (9.00–13.00)	0 (0–2.00)	−12.82	<0.001	0 (0–1.00)	−12.89	<0.001	0 (0–1.00)	−11.42	<0.001
Yes	12.00 (10.00–14.00)	0 (0–0)	−8.24	<0.001	0 (0–0)	−8.25	<0.001	0 (0–1.00)	−7.28	<0.001
Hematuria (vs preoperative)
No	11.00 (9.00–14.00)	0 (0–1.00)	−12.95	<0.001	0 (0–1.00)	−13.02	<0.001	0 (0–1.00)	−11.11	<0.001
Yes	12.00 (9.00–14.00)	0 (0–1.00)	−8.07	<0.001	0 (0–0)	−8.04	<0.001	0 (0–1.00)	−7.75	<0.001
IPSS-s (vs preoperative)
Mild	9.00 (7.00–12.00)	0 (0–2.00)	−4.38	<0.001	0 (0–0)	−4.38	<0.001	0 (0–0)	−3.41	0.001
Moderate	11.00 (9.00–13.00)	0 (0–0)	−11.21	<0.001	0 (0–1.00)	−11.22	<0.001	0 (0–1.00)	−9.95	<0.001
Severe	12.00 (10.00–15.00)	0 (0–1.50)	−9.39	<0.001	0 (0–1.00)	−9.47	<0.001	0 (0–1.00)	−8.56	<0.001
IPSS-v (vs preoperative)
Mild	5.00 (3.00–6.00)	0 (0–2.00)	−4.58	<0.001	0 (0–1.00)	−4.81	<0.001	0 (0–1.00)	−4.01	<0.001
Moderate	11.00 (9.00–13.00)	0 (0–1.00)	−12.14	<0.001	0 (0–1.00)	−12.20	<0.001	0 (0–0)	−10.55	<0.001
Severe	15.00 (14.00–15.00)	0 (0–2.00)	−8.02	<0.001	0 (0–1.00)	−8.02	<0.001	0 (0–2.00)	−7.37	<0.001
IPSS (vs preoperative)
Mild	3.00 (1.00–4.00)	0 (0)	-	-	0 (0–0)	-	-	0 (0–0)	-	-
Moderate	9.00 (7.00–10.00)	0 (0–2.00)	−9.37	<0.001	0 (0–0)	−9.40	<0.001	0 (0–0)	−7.95	<0.001
Severe	13.00 (11.00–14.00)	0 (0–1.00)	−11.95	<0.001	0 (0–1.00)	−12.01	<0.001	0 (0–2.00)	−10.85	<0.001
QoL (vs preoperative)
Good	9.00 (7.00–10.50)	0 (0–0.50)	−7.23	<0.001	0 (0–1.00)	−7.18	<0.001	0 (0–0.5)	−5.99	<0.001
Poor	12.00 (10.00–14.00)	0 (0–1.00)	−13.45	<0.001	0 (0–1.00)	−13.53	<0.001	0 (0–1.00)	−12.12	<0.001
PV (vs preoperative)
Small	12.00 (9.00–14.00)	0 (0–1.00)	−9.60	<0.001	0 (0–0)	−9.68	<0.001	0 (0–0)	−8.77	<0.001
Medium	11.00 (9.00–13.00)	0 (0–1.00)	−10.32	<0.001	0 (0–1.00)	−10.32	<0.001	0 (0–1.00)	−9.08	<0.001
Large	12.00 (8.00–14.00)	0 (0–1.00)	−5.87	<0.001	0 (0–1.00)	−5.89	<0.001	0 (0–2.00)	−4.94	<0.001
APD (vs preoperative) (cm)
<4	11.50 (9.00–14.00)	0 (0–2.00)	−8.11	<0.001	0 (0–0.25)	−8.20	<0.001	0 (0–1.00)	−7.21	<0.001
≥4	14.00 (11.00–15.00)	0 (0–1.00)	−12.92	<0.001	0 (0–1.00)	−12.93	<0.001	0 (0–1.00)	−11.47	<0.001
BWT (vs preoperative) (cm)
≤0.4	11.00 (9.00–13.00)	0 (0–1.00)	−8.35	<0.001	0 (0–1.00)	−8.39	<0.001	0 (0–1.75)	−7.37	<0.001
>0.4	12.00 (9.00–14.00)	0 (0–1.00)	−12.76	<0.001	0 (0–1.00)	−12.81	<0.001	0 (0–1.00)	−11.36	<0.001
PVR (vs preoperative)
<50 ml	11.00 (9.00–14.00)	0 (0–1.00)	−10.44	<0.001	0 (0–0)	−10.49	<0.001	0 (0–0)	−9.56	<0.001
Moderate	11.00 (10.00–13.00)	0 (0–1.00)	−5.79	<0.001	0 (0–0)	−5.79	<0.001	0 (0–0)	−4.95	<0.001
Severe	11.00 (9.00–14.00)	0 (0–1.00)	−9.50	<0.001	0 (0–1.00)	−9.54	<0.001	0 (0–2.00)	−8.23	<0.001
Bladder stone (vs preoperative)
No	11.00 (9.00–14.00)	0 (0–1.00)	−14.54	<0.001	0 (0–0.5)	−14.60	<0.001	0 (0–1.00)	−12.85	<0.001
Yes	12.00 (10.00–15.00)	0 (0–2.75)	−4.61	<0.001	0 (0–1.00)	−4.60	<0.001	0 (0–1.75)	−4.26	<0.001
Type of surgery (vs preoperative)
TURP	11.00 (9.00–13.00)	0 (0–1.75)	−13.25	<0.001	0 (0–1.00)	−13.33	<0.001	0 (0–1.00)	−11.65	<0.001
PVP	11.00 (9.00–15.00)	0 (0–1.00)	−7.55	<0.001	0 (0–0.5)	−7.53	<0.001	0 (0–1.00.5)	−6.90	<0.001
MCC (vs preoperative)
<200 ml	11.00 (9.00–13.75)	0 (0–1.00)	−12.42	<0.001	0 (0–0)	−12.48	<0.001	0 (0–1.00)	−10.62	<0.001
≥200 ml	12.00 (9.00–14.00)	0 (0–1.00)	−8.85	<0.001	0 (0–1.00)	−8.87	<0.001	0 (0–1.00)	−8.40	<0.001
BS (vs preoperative)
Reduced	11.00 (9.00–13.00)	0 (0–1.00)	−7.28	<0.001	0 (0–1.00)	−7.33	<0.001	0 (0–2.00)	−5.49	<0.001
Sensitive	11.00 (9.00–14.00)	0 (0–1.00)	−11.22	<0.001	0 (0–1.00)	−11.28	<0.001	0 (0–1.00)	−10.38	<0.001
Good	12.00 (9.00–14.00)	0 (0–2.00)	−7.36	<0.001	0 (0–0.75)	−7.33	<0.001	0 (0–1.00)	−6.77	<0.001
UIC (vs preoperative)
No	11.00 (9.00–14.00)	0 (0–1.75)	−12.95	<0.001	0 (0–1.00)	−12.98	<0.001	0 (0–1.00)	−11.46	<0.001
Yes	12.00 (9.00–14.00)	0 (0–1.00)	−8.06	<0.001	0 (0–0)	−8.11	<0.001	0 (0–0)	−7.23	<0.001
BC (vs preoperative)
Reduced	12.00 (9.75–14.00)	0 (0–1.00)	−5.59	<0.001	0 (0–1.00)	−5.59	<0.001	0 (0–2.00)	−4.84	<0.001
Good	14.00 (11.00–15.00)	0 (0–1.00)	−14.19	<0.001	0 (0–1.00)	−14.25	<0.001	0 (0–1.00)	−12.66	<0.001
DC (vs preoperative)
Reduced	11.00 (9.00–14.00)	0 (0–2.00)	−10.62	<0.001	0 (0–1.00)	−10.64	<0.001	0 (0–1.75)	−9.39	<0.001
Good	12.00 (9.00–13.25)	0 (0–0)	−10.95	<0.001	0 (0–0)	−11.01	<0.001	0 (0–1.00)	−9.75	<0.001
BOO (vs preoperative)
No	9.50 (5.00–12.00)	0.50 (0–0.75)	-	-	2.00 (0–3.00)	-	-	2.00 (0–3.00)	-	-
Suspicious	11.00 (9.00–14.00)	0 (0–2.00)	−10.15	<0.001	0 (0–1.00)	−10.17	<0.001	0 (0–1.25)	−8.88	<0.001
Yes	11.00 (9.00–14.00)	0 (0–1.00)	−11.32	<0.001	0 (0–0)	−11.38	<0.001	0 (0–1.00)	−10.15	<0.001
Qmax (vs preoperative)
<10 ml/s	11.00 (9.00–14.00)	0 (0–1.00)	−14.86	<0.001	0 (0–1.00)	−14.90	<0.001	0 (0–1.00)	−13.11	<0.001
≥10 ml/s	12.00 (9.00–13.00)	0 (0–3.50)	−3.36	0.001	0 (0–1.00)	−3.52	<0.001	0 (0–1.00)	−3.42	0.001
BOOI (vs preoperative)
<20	11.00 (9.00–14.00)	0 (0–2.00)	−8.08	<0.001	0 (0–1.00)	−8.11	<0.001	0 (0–2.00)	−6.97	<0.001
20–40	11.00 (9.00–14.00)	0 (0–2.00)	−6.54	<0.001	0 (0–1.00)	−6.63	<0.001	0 (0–0)	−6.10	<0.001
>40	11.00 (9.25–14.00)	0 (0–0.25)	−11.14	<0.001	0 (0–1.00)	−11.18	<0.001	0 (0–1.00)	−9.89	<0.001
URA (vs preoperative)
<28.9884 cmH₂O	11.00 (9.00–13.00)	0 (0–2.00)	−9.63	<0.001	0 (0–0.5)	−9.64	<0.001	0 (0–1.75)	−8.44	<0.001
≥28.9884 cmH₂O	12.00 (9.00–14.00)	0 (0–1.00)	−11.83	<0.001	0 (0–1.00)	−11.90	<0.001	0 (0–1.00)	−10.59	<0.001

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APD: anterior posterior diameter of the prostate; BC: bladder compliance; BOO: bladder outlet obstruction; BOOI: BOO index; BS: bladder sensation; BWT: bladder wall thickness; DC: detrusor contractility; IPSS: International Prostate Symptom Score; IPSS-s: IPSS (storage); IPSS-v: IPSS (voiding); IQR: interquartile range; MCC: maximum cystometric capacity; PV: prostate volume; PVR: postvoid residual urine; Qmax: maximum flow rate; QoL: quality of life; UIC: uninhibited contraction; URA: urinary resistance factor; TURP: transurethral resection of prostate; PVP: photoselective vaporization of the prostate

Supplementary Table 14.

Comparison of postoperative quality of life in subgroups of patients with benign prostatic hyperplasia

	QoL at the postoperative 1^st month			QoL at the postoperative 6^th month			QoL at the postoperative 12^th month

	Median (IQR)	Z	P	Median (IQR)	Z	P	Median (IQR)	Z	P
IPSS-s (vs severe)	3.00 (2.00–3.00)			3.00 (2.00–4.00)			1.00 (1.00–3.00)
Mild	3.00 (1.00–4.00)	−0.60	0.550	3.00 (2.00–3.00)	−0.25	0.801	2.00 (1.00–3.00)	−1.39	0.164
Moderate	3.00 (2.00–4.00)	−0.86	0.390	3.00 (1.00–4.00)	−1.27	0.206	1.00 (1.00–3.00)	−0.41	0.683
Mild vs moderate	-	−0.09	0.925	-	−0.89	0.376	-	−1.20	0.229
IPSS-v (vs severe)	3.50 (2.00–4.00)			2.00 (1.00–3.00)			1.00 (1.00–3.00)
Mild	3.00 (2.00–4.00)	−1.95	0.051	3.50 (2.00–4.00)	−0.46	0.648	1.50 (0–3.00)	−0.76	0.445
Moderate	2.00 (1.00–3.00)	−1.40	0.163	3.00 (2.00–4.00)	−1.10	0.271	1.00 (1.00–3.00)	−1.38	0.168
Mild vs moderate	-	−1.45	0.146	-	−0.22	0.830	-	−0.05	0.958
IPSS (vs severe)	2.00 (1.00–3.00)			3.00 (1.00–3.00)			1.00 (1.00–3.00)
Mild	3.00 (2.00–4.00)	-	-	1.00 (1.00–1.50)	-	-	1.00 (0–1.00)	-	-
Moderate	3.00 (1.00–3.00)	−1.93	0.054	3.00 (2.00–4.00)	−0.39	0.698	2.00 (1.00–3.00)	−0.25	0.801
Mild vs moderate	-	−0.76	0.488	-	−0.09	0.931	-	−0.78	0.467
QoL (vs good)	3.00 (2.00–4.00)			3.00 (2.00–4.00)			2.00 (0–3.00)
Poor	3.00 (1.00–3.00)	−0.10	0.924	3.00 (1.00–3.00)	−1.94	0.053	1.00 (1.00–3.00)	−0.83	0.405
PV (vs small)	3.00 (2.00–3.00)			3.00 (2.00–3.00)			1.00 (1.00–3.00)
Medium	3.00 (1.00–4.00)	−0.55	0.579	3.00 (1.00–4.00)	−0.38	0.708	2.00 (1.00–3.00)	−0.80	0.422
Large	2.00 (1.00–3.75)	−1.05	0.293	2.00 (1.00–3.75)	−0.75	0.451	1.00 (1.00–2.00)	−0.99	0.322
Large vs medium	-	−0.79	0.429	-	−1.06	0.289	-	−0.38	0.701
BWT (vs ≤0.4 cm)	3.00 (2.00–3.00)			3.00 (2.00–3.00)			2.00 (1.00–3.00)
>0.4 cm	3.00 (1.00–4.00)	−0.47	0.642	3.00 (1.00–4.00)	−0.04	0.970	1.00 (1.00–3.00)	−0.63	0.527
APD (vs <4 cm)	3.00 (1.00–3.00)			1.00 (1.00–3.00)			1.00 (0–3.00)
≥4 cm	3.00 (1.00–3.00)	−0.17	0.863	1.00 (1.00–3.00)	−0.29	0.774	1.00 (1.00–3.00)	−0.77	0.444
BS (vs reduced)	2.00 (1.00–3.00)			2.00 (1.00–2.00)			1.00 (1.00–3.00)
Sensitive	3.00 (2.00–4.00)	−2.60	0.009	2.00 (1.00–3.00)	−1.09	0.278	2.00 (1.00–3.00)	−0.28	0.777
Good	3.00 (1.00–3.00)	−1.78	0.075	1.00 (1.00–3.00)	−0.11	0.915	1.00 (1.00–3.00)	−0.71	0.479
Sensitive vs good	-	−1.42	0.156	-	−1.27	0.203	-	−1.27	0.204
UIC (vs no)	3.00 (1.00–4.00)			3.00 (1.00–4.00)			2.00 (1.00–3.00)
Yes	3.00 (2.00–3.00)	−0.06	0.950	3.00 (2.00–3.00)	−0.55	0.586	1.00 (1.00–3.00)	−0.26	0.799
BC (vs good)	3.00 (2.00–4.00)			3.00 (1.00–3.25)			1.00 (1.00–3.00)
Reduced	3.00 (1.00–3.25)	−0.23	0.815	3.00 (2.00–4.00)	−2.21	0.027	3.00 (1.00–3.00)	−2.29	0.022
DC (vs reduced)	3.00 (2.00–4.00)			3.00 (2.00–4.00)			2.00 (1.00–3.00)
Good	3.00 (1.00–3.00)	−0.81	0.419	3.00 (1.00–3.00)	−2.11	0.035	1.00 (1.00–3.00)	−1.79	0.073
BOOI (vs >40)	3.00 (2.00–4.00)			3.00 (1.00–3.00)			1.50 (1.00–3.00)
<20	2.00 (1.00–3.25)	−0.85	0.396	3.00 (2.00–4.00)	−0.68	0.499	2.00 (1.00–3.00)	−1.30	0.195
20–40	3.00 (1.00–3.00)	−0.03	0.979	2.00 (1.00–3.25)	−0.38	0.705	1.00 (0.75–3.00)	−0.79	0.430
20–40 vs <20	-	−0.69	0.494	-	−0.82	0.414	-	−1.57	0.117

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Supplementary Table 15.

Comparison of postoperative International Prostate Symptom Score in subgroups of patients with benign prostatic hyperplasia

	IPSS at the postoperative 1^st month			IPSS at the postoperative 6^th month			IPSS at the postoperative 12^th month

	Median (IQR)	Z	P	Median (IQR)	Z	P	Median (IQR)	Z	P
IPSS-s (vs severe)	4.00 (2.00–5.00)			3.00 (2.00–5.00)			3.00 (2.00–5.50)
Mild	2.00 (1.00–6.00)	−1.45	0.146	2.00 (1.00–4.00)	−1.75	0.081	2.00 (1.00–3.00)	−2.30	0.022
Moderate	3.00 (1.50–5.00)	−2.54	0.011	2.00 (1.00–5.00)	−1.75	0.079	2.00 (1.00–5.00)	−1.50	0.134
Mild vs moderate	-	−0.31	0.757	-	−0.79	0.429	-	−1.58	0.126
IPSS-v (vs severe)	4.00 (2.00–5.00)			3.00 (2.00–5.00)			3.00 (2.00–6.00)
Mild	2.50 (1.00–7.25)	−1.00	0.319	2.00 (1.00–5.00)	−1.80	0.072	2.00 (1.00–7.00)	−1.55	0.122
Moderate	3.00 (2.00–5.00)	−1.56	0.119	2.00 (1.00–5.00)	−2.69	0.007	2.00 (1.00–4.00)	−2.57	0.010
Mild vs moderate	-	−0.06	0.956	-	−0.16	0.876	-	−0.02	0.984
IPSS (vs severe)	3.00 (2.00–5.00)			2.00 (1.00–5.00)			3.00 (1.00–5.00)
Mild	1.00 (0.50–1.00)	-	-	1.00 (1.00–1.00)	-	-	1.00 (1.00–1.00)	-	-
Moderate	4.00 (2.00–6.00)	−0.41	0.681	2.00 (1.00–5.00)	−0.94	0.349	2.00 (1.00–5.00)	−1.11	0.265
Mild vs moderate	-	−1.64	0.108	-	−1.88	0.068	-	−1.81	0.082
QoL (vs good)	3.00 (2.00–6.00)			2.00 (1.00–5.00)			2.00 (1.00–5.50)
Poor	3.00 (2.00–5.00)	−0.30	0.765	2.00 (1.00–5.00)	−1.15	0.248	2.50 (1.00–5.00)	−0.74	0.459
PV (vs small)	4.00 (2.00–5.00)			3.00 (1.00–5.00)			2.00 (1.00–5.00)
Medium	3.00 (2.00–5.00)	−1.48	0.138	2.00 (1.00–5.00)	−1.05	0.295	2.50 (1.00–6.00)	−0.35	0.723
Large	3.00 (2.00–4.00)	−1.32	0.188	2.00 (1.00–4.75)	−1.21	0.228	2.00 (1.00–5.00)	−0.27	0.790
Large vs medium	-	−0.08	0.940	-	−0.42	0.674	-	−0.54	0.592
BWT (vs ≤0.4 cm)	3.50 (2.00–5.00)			3.00 (2.00–5.00)			3.00 (2.00–6.00)
>0.4 cm	3.00 (2.00–5.00)	−1.00	0.318	2.00 (1.00–5.00)	−1.44	0.151	2.00 (1.00–5.00)	−1.71	0.087
APD (vs <4 cm)	4.00 (2.00–6.00)			3.00 (1.00–5.00)			3.00 (1.75–5.00)
≥4 cm	3.00 (2.00–5.00)	−2.61	0.009	2.00 (1.00–4.00)	−1.19	0.235	2.00 (1.00–5.00)	−1.07	0.287
BS (vs reduced)	3.00 (1.00–5.00)			2.00 (1.00–4.00)			3.00 (1.00–6.00)
Sensitive	4.00 (2.00–6.00)	−1.70	0.090	3.00 (1.25–5.00)	−1.99	0.051	3.00 (2.00–7.00)	−1.24	0.213
Good	3.00 (2.00–5.00)	−0.98	0.328	2.00 (1.00–4.00)	−0.32	0.747	2.00 (1.00–4.50)	−0.23	0.821
Sensitive vs good	-	−1.27	0.205	-	−2.37	0.018	-	−2.43	0.015
UIC (vs no)	3.00 (2.00–5.00)			2.00 (1.00–5.00)			2.00 (1.00–5.00)
Yes	3.00 (2.00–5.00)	−2.71	0.476	3.00 (1.00–5.00)	−1.15	0.251	3.00 (1.00–5.00)	−0.73	0.466
BC (vs good)	3.00 (2.00–5.00)			2.00 (1.00–4.25)			2.00 (1.00–5.00)
Reduced	4.00 (2.00–6.00)	−1.13	0.258	5.00 (2.00–6.00)	−2.01	0.044	4.00 (2.00–7.00)	−2.02	0.043
DC (vs reduced)	4.00 (2.00–6.00)			3.00 (2.00–5.00)			3.00 (1.00–6.75)
Good	3.00 (1.00–4.00)	−3.20	0.001	2.00 (1.00–4.00)	−2.47	0.014	2.00 (1.00–4.00)	−2.54	0.011
BOOI (vs >40)	3.00 (2.00–4.00)			2.00 (1.00–4.25)			2.00 (1.00–4.00)
<20	4.00 (2.00–6.00)	−2.41	0.016	2.00 (1.00–5.00)	−0.78	0.439	3.00 (1.00–7.00)	−1.50	0.134
20–40	3.50 (1.00–6.25)	−1.48	0.140	3.00 (1.00–5.25)	−0.71	0.478	2.00 (1.00–6.00)	−0.44	0.660
20–40 vs <20	-	−0.25	0.802	-	−0.12	0.902	-	−0.71	0.478

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Supplementary Table 16.

Comparison of postoperative International Prostate Symptom Score (storage) in subgroups of patients with benign prostatic hyperplasia

	IPSS-s at the postoperative 1^st month			IPSS-s at the postoperative 6^th month			IPSS-s at the postoperative 12^th month

	Median (IQR)	Z	P	Median (IQR)	Z	P	Median (IQR)	Z	P
IPSS-s (vs severe)	3.00 (2.00–4.00)			3.00 (2.00–4.00)			2.00 (1.00–4.00)
Mild	2.00 (1.00–5.00)	−1.228	0.219	2.00 (1.00–3.00)	−1.484	0.138	2.00 (1.00–3.00)	−1.735	0.083
Moderate	2.00 (1.00–4.00)	−2.213	0.027	2.00 (1.00–4.00)	−1.774	0.076	2.00 (1.00–4.00)	−1.633	0.102
Mild vs moderate	-	−0.290	0.772	-	−0.507	0.612	-	−0.958	0.338
IPSS-v (vs severe)	3.00 (2.00–4.00)			3.00 (2.00–4.00)			2.00 (2.00–4.75)
Mild	2.00 (1.00–5.00)	−0.897	0.369	2.00 (1.00–3.25)	−1.831	0.067	2.00 (1.00–4.25)	−1.320	0.187
Moderate	2.00 (1.00–4.00)	−1.854	0.064	2.00 (1.00–3.00)	−2.895	0.004	2.00 (1.00–3.00)	−2.260	0.024
Mild vs moderate	-	−0.310	0.756	-	−0.002	0.999	-	−0.103	0.918
IPSS (vs severe)	3.00 (2.00–4.00)			2.00 (1.00–4.00)			2.00 (1.00–4.00)
Mild	1.00 (1.00–1.00)	-	-	1.00 (1.00–1.00)	-	-	1.00 (1.00–1.00)	-	-
Moderate	3.00 (1.50–4.50)	−0.635	0.525	2.00 (1.00–4.00)	−0.745	0.456	2.00 (1.00–4.00)	−0.275	0.783
Mild vs moderate	-	−1.836	0.07	-	−1.765	0.093	-	−1.746	0.096
QoL (vs good)	3.00 (2.00–5.00)			2.00 (1.00–4.50)			2.00 (1.00–4.00)
Poor	3.00 (2.00–4.00)	−0.484	0.628	2.00 (1.00–4.00)	−1.024	0.306	2.00 (1.00–4.00)	−0.222	0.824
PV (vs small)	3.00 (2.00–4.00)			2.00 (1.00–4.00)			2.00 (1.00–4.00)
Medium	2.00 (1.00–4.00)	−1.801	0.072	2.00 (1.00–4.00)	−1.600	0.110	2.00 (1.00–4.00)	−0.183	0.855
Large	2.00 (2.00–4.00)	−1.452	0.146	2.00 (1.00–3.00)	−1.593	0.111	2.00 (1.00–3.75)	−1.056	0.291
Large vs medium	-	−0.078	0.938	-	−0.430	0.667	-	−0.949	0.343
BWT (vs ≤0.4 cm)	3.00 (2.00–4.00)			2.00 (1.00–4.00)			2.00 (1.25–4.00)
>0.4 cm	2.00 (1.50–4.00)	−1.167	0.243	2.00 (1.00–4.00)	−1.247	0.212	2.00 (1.00–3.50)	−1.825	0.068
APD (vs <4 cm)	3.00 (2.00–5.00)			2.00 (1.00–4.00)			2.00 (1.00–4.00)
≥4 cm	2.00 (2.00–4.00)	−2.221	0.026	2.00 (1.00–3.00)	−1.319	0.187	2.00 (1.00–4.00)	−1.347	0.178
BS (vs reduced)	2.00 (1.00–4.00)			2.00 (1.00–4.50)			2.00 (1.00–4.00)
Sensitive	3.00 (2.00–5.00)	−1.820	0.069	3.00 (1.00–5.00)	−1.970	0.051	3.00 (2.00–5.00)	−1.563	0.118
Good	3.00 (2.00–4.00)	−0.483	0.629	2.00 (1.00–3.00)	−0.500	0.617	2.00 (1.00–3.00)	−0.066	0.948
Sensitive vs good	-	−2.009	0.044	-	−2.443	0.015	-	−2.648	0.008
UIC (vs no)	2.50 (2.00–4.00)			2.00 (1.00–4.00)			2.00 (1.00–4.00)
Yes	3.00 (2.00–4.00)	−0.689	0.491	2.00 (1.00–4.00)	−1.499	0.134	2.00 (1.00–4.00)	−1.271	0.204
BC (vs good)	2.50 (2.00–4.00)			2.00 (1.00–3.00)			2.00 (1.00–3.25)
Reduced	3.00 (2.00–6.00)	−1.108	0.268	4.00 (2.00–5.00)	−2.245	0.025	3.00 (2.00–6.00)	−2.409	0.016
DC (vs reduced)	3.00 (2.00–4.00)			2.00 (1.00–4.00)			2.00 (1.00–5.00)
Good	2.00 (1.00–4.00)	−2.974	0.003	2.00 (1.00–3.00)	−3.042	0.002	2.00 (1.00–3.00)	−2.988	0.003
BOOI (vs >40)	2.00 (2.00–4.00)			2.00 (1.00–3.00)			2.00 (1.00–3.00)
<20	3.00 (2.00–4.50)	−1.728	0.084	2.00 (1.00–4.00)	−0.861	0.389	2.00 (1.00–4.00)	−1.114	0.265
20–40	3.00 (1.00–5.00)	−1.472	0.141	2.50 (1.00–5.00)	−1.237	0.216	2.00 (1.00–5.00)	−1.244	0.213
20–40 vs <20	-	−0.010	0.992	-	−0.433	0.665	-	−0.245	0.806

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Influence of preoperative LUTS on surgical outcomes in patients with BPH

In general, the QoL of patients with BPH was positively correlated with IPSS, IPSS-s, and IPSS-v (all P < 0.001). Patients with different preoperative QoL and IPSS-v all had significant improvements (all P < 0.001). No obvious postoperative differences were identified between QoL subgroups (all P > 0.05), but the QoL improvement in patients with high preoperative QoL was more significant than that of those with low QoL (odds ratio [OR] = 3.53, 95% confidence interval [CI]: 2.05–6.08, P < 0.001). Similarly, the QoL improvement in patients with severe IPSS-v was more obvious than that of patients with mild IPSS-v (P = 0.010). Additionally, patients with moderate IPSS-v had lower levels of IPSS, IPSS-s, and IPSS-v at the 12^th month postoperatively (all P < 0.05) than those with severe IPSS-v. Besides, severe IPSS-s was associated with a marked improvement in IPSS-s (r = 0.563, P = 0.042), but higher IPSS, IPSS-s, and IPSS-v at the 1^st month postoperatively than moderate IPSS-s (all P < 0.05). Similarly, severe IPSS predicted a more significant QoL improvement than moderate IPSS (r = 0.507, P = 0.006); but a higher IPSS-v (median [IQR]) at the 6^th month postoperatively (0 [0–0] vs 0 [0–2.00], P = 0.011).

Influence of imaging data on surgical outcomes in patients with BPH

According to the imaging data, all patients exhibited significant improvements (all P < 0.001). The median (IQR) of preoperative IPSS-v of patients with a BWT >0.4 cm was higher than that of patients with a BWT ≤0.4 cm (11.00 [9.00–13.00] vs 12.00 [9.00–14.00], P = 0.030), but there were no significant differences in the improvements and postoperative levels of postoperative indicators between them (all P > 0.05). At the 12^th month postoperatively, the IPSS-s of patients with BPH with large PVs improved more significantly than those with small PVs (OR = 1.734, P = 0.008). However, there were no significant differences in the postoperative levels among patients with different PVs (all P > 0.05). In addition, no significant correlation was identified between APD and the improvement of postoperative indicators in patients with BPH (all P > 0.05).

Influence of UDS on surgical outcomes in patients with BPH

Normal BS endowed patients with a higher median (IQR) preoperative QoL (5.00 [5.00–6.00] vs 5.00 [4.00–5.00], P = 0.003) but more significant improvements in QoL (r = 0.943, P < 0.001), IPSS (r = 1.025, P = 0.045), and IPSS-s (r = 1.145, P = 0.001) than sensitive bladder. Patients with normal BS had lower IPSS and IPSS-s levels at the 6^th and 12^th months postoperatively than those with sensitive bladder (all P < 0.05). Similarly, patients with normal BS had significantly higher preopertaive IPSS and IPSS-s levels and IPSS improvement than those with reduced BS (all P < 0.05), yet there was no significant difference in postoperative indicators between them (all P > 0.05).

The BC decrement in patients with BPH was negatively correlated with postoperative improvements in IPSS-s (r = −0.746, P = 0.044) and QoL (r = −0.603, P = 0.026), and patients with normal BC had lower QoL, IPSS, and IPSS-s at the 6^th and 12^th months postoperatively than those with decreased BC (all P < 0.05). In addition, as judged by the LinPURR nomogram, there was no significant difference in preoperative indicators between patients with good and reduced DC (all P > 0.05). After TURP or PVP, patients with good DC had better improvements in IPSS, IPSS-s, and IPSS-v (all P < 0.05) and lower postoperative IPSS and IPSS-s levels (both P < 0.05) than those with reduced DC.

Patients with BPH with suspected BOO and definite BOO achieved significant improvements (both P < 0.001), but there were no obvious differences in pre- and postoperative IPSS and QoL improvement (all P > 0.05) between them. However, another indicator reflecting the severity of BOO, BOOI, may be related to their recovery. Indeed, the improvements in IPSS in patients with BOOI >40 were more significant than those in patients with BOOI <20 (r = 1.084, P = 0.041) and >40 (r = 1.220, P = 0.026). Simultaneously, BOOI >40 predicted lower IPSS and IPSS-v levels at the 1^st month postoperatively compared to BOOI <20 and 20–40, respectively (all P < 0.05). Nevertheless, other UDS indicators were not significantly related to improved postoperative recovery of patients with BPH.

Influence of urinary indicators and surgical outcomes in patients with BPH

There was no significant difference in urinary Cr (median [IQR]) between patients with BPH and healthy participants (97.95 ± 8.90 mg dl⁻¹ vs 100.15 ± 9.43 mg dl⁻¹, P = 0.881; Table 2). However, the levels of BDNF, NGF, and PGE2 and normalization by urinary Cr concentration (BDNF/Cr, NGF/Cr, and PGE2/Cr) in patients were higher than those in healthy participants (all P < 0.01; Figure 1).

Table 2.

Characteristics of patients with benign prostatic hyperplasia and healthy participants in the urine test

Indicator	Patients with BPH (n=30)	Healthy participants (n=30)	P
Age (year), median (IQR)	68.0 (64.0–76.0)	39.5 (26.0–46.8)	<0.001
Preoperative IPSS, median (IQR)	20.00 (15.0–25.00)	0 (0)	<0.001
Preoperative IPSS-s, median (IQR)	10.00 (7.00–11.00)	0 (0)	<0.001
Preoperative IPSS-v, median (IQR)	11.00 (7.75–14.00)	0 (0)	<0.001
PdetQmax (cmH₂O), median (IQR)	61.50 (28.25–96.75)	0 (0)	<0.001
BOOI, median (IQR)	43.50 (11.00–87.25)	0 (0)	<0.001
URA (cmH₂O), median (IQR)	29.73 (18.02–63.87)	0 (0)	<0.001
Urinary Cr (mg dl⁻¹), mean±s.d.	97.95±8.90	100.15±9.43	0.881
BDNF (pg ml⁻¹), mean±s.d.	106.89±21.66	41.08±12.19	<0.001
BDNF/Cr (pg mg⁻¹), mean±s.d.	1.10±0.25	0.08±0.030	<0.001
NGF (pg ml⁻¹), mean±s.d.	113.31±15.00	10.14±9.65	<0.001
NGF/Cr (pg mg⁻¹), mean±s.d.	1.16±0.17	0.18±0.10	<0.001
PGE2 (pg ml⁻¹), mean±s.d.	156.10±45.62	120.75±47.27	0.002
PGE2/Cr (pg mg⁻¹), mean±s.d.	1.61±0.49	1.21±0.51	<0.001

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BDNF: brain-derived neurotrophic factor; BOOI: bladder outlet obstruction index; BPH: benign prostatic hyperplasia; Cr: creatine; IPSS: International Prostate Symptom Score; IPSS-s: IPSS storage; IPSS-v: IPSS voiding; IQR: interquartile range; NGF: nerve growth factor; Qmax: maximum flow rate; PdetQmax: detrusor pressure at Qmax; PGE2: prostaglandin estradiol; s.d.: standard deviation; URA: urinary resistance factor

Comparison of urinary concentrations of (a) BDNF, NGF, and PGE2, and (b) BDNF/Cr, NGF/Cr, and PGE2/Cr in patients with BPH and healthy participants. ^**P < 0.01, ^***P < 0.001. BDNF: brain-derived neurotrophic factor; BPH: benign prostatic hyperplasia; Cr: creatine; NGF: nerve growth factor; PGE2: prostaglandin estradiol.

According to the correlation analysis of perioperative indicators with urine molecules (Supplementary Table 18), those with possible correlations with urinary indicators were included (Supplementary Table 19). Marked differences were identified in the median urinary concentrations of NGF/Cr (1.21 [1.04–1.33] pg mg⁻¹ vs 0.92 [0.88–1.21] pg mg⁻¹, P = 0.042) and PGE2/Cr (1.81 [1.40–1.97] pg mg⁻¹ vs 1.28 [0.94–1.56] pg mg⁻¹, P = 0.037) between patients with and without dysuria. The urinary concentrations of three urinary indicators in patients with BOOI >40 were significantly higher than those with BOOI <20 (all P < 0.05). Furthermore, UIC, DC, and URA were valid classification criteria for distinguishing the concentrations of these three urinary molecules in patients with BPH (all P < 0.05). Thus, UIC, DC, URA, and dysuria were identified and stratified by UDS data, and ROC curves of three urinary indicators for independent and joint diagnosis of UIC, DC, URA, and dysuria were depicted (Figure 2 and 3).

Supplementary Table 18.

Correlation analysis between urinary molecules and perioperative indicators in patients with benign prostatic hyperplasia

Indicators	r/P	BDNF/Cr	NGF/Cr	PGE2/Cr	Indicators	r/P	BDNF/Cr	NGF/Cr	PGE2/Cr
QoL change (postoperative 1^st month)	r	−0.012	0.012	−0.002	Hematuria	r	0.039	0.056	0.073
QoL change (postoperative 1^st month)	P	0.928	0.928	0.986	Hematuria	P	0.802	0.718	0.636
IPSS change (postoperative 1^st month)	r	0.216	0.160	0.207	PV	r	−0.037	−0.032	−0.032
IPSS change (postoperative 1^st month)	P	0.161	0.300	0.180	PV	P	0.775	0.803	0.803
IPSS-s change (postoperative 1^st month)	r	0.152	0.108	0.116	APD	r	−0.021	0.007	−0.110
IPSS-s change (postoperative 1^st month)	P	0.325	0.482	0.453	APD	P	0.872	0.957	0.400
IPSS-v change (postoperative 1^st month)	r	0.261	0.304*	0.176	BWT	r	0.237	0.232	0.161
IPSS-v change (postoperative 1^st month)	P	0.090	0.049	0.254	BWT	P	0.085	0.092	0.241
QoL change (postoperative 6^th month)	r	−0.172	−0.079	−0.216	PVR	r	−0.102	−0.098	−0.088
QoL change (postoperative 6^th month)	P	0.205	0.562	0.111	PVR	P	0.431	0.452	0.497
IPSS change (postoperative 6^th month)	r	−0.009	−0.151	−0.009	Bladder stone	r	0.205	0.187	0.223
IPSS change (postoperative 6^th month)	P	0.954	0.326	0.954	Bladder stone	P	0.184	0.225	0.149
IPSS-s change (postoperative 6^th month)	r	0.160	0.112	0.056	Type of surgery	r	−0.339*	−0.279	−0.227
IPSS-s change (postoperative 6^th month)	P	0.300	0.468	0.717	Type of surgery	P	0.028	0.071	0.140
IPSS-v change (postoperative 6^th month)^#	r	−	−	−	MCC	r	−0.018	−0.046	0.014
IPSS-v change (postoperative 6^th month)^#	P	−	−	−	MCC	P	0.886	0.721	0.915
Preoperative IPSS	r	0.127	0.061	0.009	BS	r	−0.281	−0.281	−0.259
Preoperative IPSS	P	0.334	0.642	0.943	BS	P	0.054	0.054	0.076
Preoperative IPSS-s	r	0.055	−0.017	0.027	UIC	r	0.319*	0.339*	0.353*
Preoperative IPSS-s	P	0.678	0.900	0.843	UIC	P	0.039	0.028	0.022
Preoperative IPSS-v	r	0.141	0.098	−0.002	BC	r	−0.236	−0.253	−0.090
Preoperative IPSS-v	P	0.289	0.461	0.986	BC	P	0.126	0.101	0.559
Preoperative QoL	r	0.195	0.173	0.031	DC	r	−0.432**	−0.393*	−0.412**
Preoperative QoL	P	0.183	0.239	0.832	DC	P	0.005	0.011	0.007
Age	r	0.148	0.138	0.024	BOO	r	0.167	0.154	0.192
Age	P	0.265	0.297	0.857	BOO	P	0.280	0.318	0.212
BMI	r	−0.067	−0.044	−0.164	Qmax	r	<0.001	−0.033	−0.086
BMI	P	0.605	0.735	0.205	Qmax	P	1.000	0.801	0.518
Course of disease	r	0.171	0.067	0.124	PdetQmax	r	0.510**	0.487**	0.459**
Course of disease	P	0.196	0.615	0.350	PdetQmax	P	<0.001	<0.001	<0.001
Urinary retention	r	0.222	0.262	0.196	BOOI	r	0.511**	0.483**	0.474**
Urinary retention	P	0.149	0.089	0.204	BOOI	P	<0.001	<0.001	<0.001
Dysuria	r	−0.236	−0.313*	−0.322*	URA	r	0.477**	0.463**	0.468**
Dysuria	P	0.126	0.042	0.037	URA	P	<0.001	<0.001	<0.001

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*P<0.05; **P<0.01; ^#Data may contain complete separation: Which is not suitable for Kendall’s tau-b test. APD: anterior posterior diameter of the prostate; BMI: body mass index; BC: bladder compliance; BOO: bladder outlet obstruction; BOOI: BOO index; BS: bladder sensation; BWT: bladder wall thickness; DC: detrusor contractility; IPSS: International Prostate Symptom Score; IPSS-s: IPSS (storage); IPSS-v: IPSS (voiding); MCC: maximum cystometric capacity; Qmax: maximum flow rate; PdetQmax: detrusor pressure at Qmax; PV: prostate volume; PVR: postvoid residual urine; QoL: quality of life; UIC: uninhibited contraction; URA: urinary resistance factor; Cr: creatine; BDNF: brain-derived neurotrophic factor; NGF: nerve growth factor; PGE2: Prostaglandin E2

Supplementary Table 19.

Relationship between preoperative indexes and brain-derived neurotrophic factor/creatine, nerve growth factor/creatine and prostaglandin E2/creatine in urine of patients with benign prostatic hyperplasia

Indicators	BDNF/Cr			NGF/Cr			PGE2/Cr

	Median (IQR)	Z	P	Median (IQR)	Z	P	Median (IQR)	Z	P
Dysuria (vs no)	1.18 (0.95–1.32)			1.21 (1.04–1.33)			1.81 (1.40–1.97)
Yes	0.80 (0.71–1.23)	−1.53	0.136	0.92 (0.88–1.21)	−2.03	0.042	1.28 (0.94–1.56)	−2.09	0.037
BS (vs sensitive)	1.22 (1.06–1.42)			1.24 (1.16–1.40)			1.74 (1.45–2.14)
Normal	1.20 (0.92–1.30)	−0.66	0.545	1.20 (1.02–1.35)	−1.16	0.272	1.81 (1.57–1.91)	<0.01	1.000
Reduced	0.96 (0.74–1.20)	−1.90	0.062	1.06 (0.94–1.28)	−1.90	0.062	1.38 (1.12–1.66)	−1.57	0.129
Normal vs reduced	-	−1.28	0.217	-	−0.89	0.401	-	−1.81	0.076
UIC (vs no)	1.06 (0.80–1.21)			1.14 (0.95–1.23)			1.56 (1.19–1.81)
Yes	1.27 (1.01–1.43)	−2.07	0.039	1.26 (1.13–1.42)	−2.20	0.028	1.96 (1.55–2.21)	−2.29	0.022
BC (vs good)	1.04 (0.84–1.29)			1.14 (1.00–1.29)			1.59 (1.21–1.97)
Reduced	1.20 (1.16–1.42)	−1.53	0.136	1.23 (1.21–1.39)	−1.64	0.108	1.81 (1.57–1.89)	−0.58	0.589
DC (vs reduced)	0.95 (0.74–1.18)			1.02 (0.92–1.21)			1.42 (1.01–1.66)
Good	1.22 (1.14–1.40)	−2.80	0.004	1.23 (1.20–1.35)	−2.55	0.010	1.88 (1.60–2.02)	−2.68	0.007
BOO (vs suspicious)	1.13 (0.73–1.28)			1.17 (0.94–1.29)			1.56 (0.94–1.95)
Yes	1.17 (0.95–1.38)	−1.08	0.294	1.21 (1.07–1.34)	−1.00	0.334	1.81 (1.42–1.92)	−1.25	0.224
BOOI (vs >40)	1.24 (1.15–1.38)			1.24 (1.20–1.37)			1.89 (1.65–2.06)
<20	0.91 (0.71–1.05)	−3.11	0.001	1.08 (0.91–1.14)	−3.27	0.001	1.34 (0.71–1.57)	−3.43	<0.001
20–40	1.07 (0.84–1.36)	−1.23	0.249	1.18 (1.00–1.37)	−0.66	0.55	1.41 (1.13–2.05)	−1.32	0.211
20–40 vs <20	-	−1.27	0.240	-	−1.56	0.142	-	−0.99	0.374
URA (vs <28.9884 cmH₂O)	0.95 (0.73–1.13)			1.02 (0.93–1.18)			1.42 (0.87–1.63)
≥28.9884 cmH₂O	1.22 (1.05–1.36)	−2.78	0.004	1.23 (1.16–1.37)	−2.49	0.012	1.88 (1.57–2.05)	−2.87	0.003

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BC: bladder compliance; BDNF: brain-derived neurotrophic factor; BOO: bladder outlet obstruction; BOOI: BOO index; BS: bladder sensation; NGF: nerve growth factor; PGE2: Prostaglandin E2; UIC: uninhibited contraction; URA: urinary resistance factor; Cr: creatine; IQR: interquartile range; DC: detrusor contractility

ROC analysis of urinary molecules of (a) UIC, (b) DC, (c) URA, and (d) dysuria of patients with BPH. AUC: area under the curve; BPH: benign prostatic hyperplasia; DC: detrusor contractility; ROC: receiver operating characteristic; UIC: uninhibited contraction; URA: urethral resistance factor.

ROC analysis of (a) bladder UIC, (b) DC, and (c) URA in patients with BPH jointly diagnosed by three urinary molecules. AUC: area under the curve; BPH: benign prostatic hyperplasia; CI: confidence interval; DC: detrusor contractility; ROC: receiver operating characteristic; UIC: uninhibited contraction; URA: urethral resistance factor.

When using UIC, DC, and URA as the classification standard, the respective cutoffs of BDNF/Cr, NGF/Cr, and PGE2/Cr levels were 1.200 pg mg⁻¹, 1.237 pg mg⁻¹, and 1.889 pg mg⁻¹ by UIC; 1.106 pg mg⁻¹, 1.083 pg mg⁻¹, and 1.744 pg mg⁻¹ by DC; and 1.177 pg mg⁻¹, 1.177 pg mg⁻¹, and 1.744 pg mg⁻¹ by URA (all P < 0.05; Supplementary Table 20–22). When urinary indicators were used to jointly diagnose UIC, DC, and URA, the average weighted AUC (95% CI) was 0.780 (0.596–0.964), 0.809 (0.647–0.971), and 0.824 (0.663–0.984), respectively. The probability of UIC, DC, and URA in patients with BPH was e^{logit (P)}/(1 + e^{logit (P)}) and logit (P)=−7.934−2.003×BDNF/Cr+5.240×NGF/Cr+1.935×PGE2/Cr, −5.927+3.629×BDNF/Cr−0.716×NGF/Cr+1.688×PGE2/Cr, and −5.155+2.424×BDNF/Cr−0.886×NGF/Cr+2.401×PGE2/Cr, respectively. However, urinary indicators were not good predictors of dysuria (Supplementary Table 23).

Supplementary Table 20.

Receiver operating characteristic curve analysis of uninhibited contraction assessed by urine indicators in patients with benign prostatic hyperplasia

Urinary indicators	Cutoff (pg/mg)	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)	AUC (95% CI)	P
BDNF/Cr	1.200	70.00	75.00	58.30	83.30	0.735 (0.539–0.931)	0.039
NGF/Cr	1.237	60.00	80.00	60.00	80.00	0.750 (0.567–0.933)	0.028
PGE2/Cr	1.889	60.00	85.00	66.70	81.00	0.760 (0.564–0.956)	0.022
Combined	-	80.00	65.00	53.33	86.70	0.780 (0.596–0.964)	-

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AUC: area under the curve; BDNF: brain-derived neurotrophic factor; CI: confidence interval; NGF: nerve growth factor; NPV: negative predictive value; PGE2: Prostaglandin E2; PPV: positive predictive value; UIC: uninhibited contraction; Cr: creatine

Supplementary Table 22.

Receiver operating characteristic curve of urethral resistance factor assessed by urine indicators in patients with benign prostatic hyperplasia

Urinary indicators	Cutoff (pg/mg)	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)	AUC (95% CI)	P
BDNF/Cr	1.177	70.60	84.60	85.70	68.80	0.801 (0.637–0.965)	0.005
NGF/Cr	1.177	76.50	76.90	81.30	71.40	0.769 (0.593–0.946)	0.013
PGE2/Cr	1.744	70.60	92.30	92.30	70.60	0.810 (0.646–0.974)	0.004
Combined	-	64.70	92.30	91.70	66.70	0.824 (0.663–0.984)	-

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AUC: area under the curve; BDNF: brain-derived neurotrophic factor; CI: confidence interval; NGF: nerve growth factor; NPV: negative predictive value; PGE2: prostaglandin E2; PPV: positive predictive value; Cr: creatine

Supplementary Table 23.

Receiver operating characteristic curve of dysuria assessed by urine indicators in patients with benign prostatic hyperplasia

Urinary indicators	Cutoff (pg/mg)	Specificity (%)	PPV (%)	NPV (%)	AUC (95% CI)	P
BDNF/Cr	2.534	100.00	-	63.33	0.280 (0.022–0.538)	0.126
NGF/Cr	2.455	100.00	-	63.33	0.208 (0.000–0.437)	0.042
PGE2/Cr	3.682	100.00	-	63.33	0.200 (0.037–0.363)	0.037

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Supplementary Table 21.

Receiver operating characteristic curve of detrusor contractility assessed by urine indicators in patients with benign prostatic hyperplasia

Urinary indicators	Cutoff (pg/mg)	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)	AUC (95% CI)	P
BDNF/Cr	1.106	80.00	73.30	78.60	75.00	0.800 (0.639–0.961)	0.005
NGF/Cr	1.083	93.30	60.00	75.00	78.60	0.773 (0.599–0.948)	0.011
PGE2/Cr	1.744	73.30	86.70	84.60	76.50	0.787 (0.614–0.960)	0.007
Combined	-	93.30	60.00	70.00	90.00	0.809 (0.647–0.971)	-

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According to GEE and ROC analysis of preoperative indicators and surgical outcomes, the preoperative DC was the only parameter that was significantly related to both urinary indicators and the improvement of postoperative indicators. Therefore, 30 patients with BPH were divided into good and reduced DC groups based on the cutoff of urinary indicators to predict DC, and further analyses were conducted (Supplementary Table 24−35). All of the patients in different subgroups obtained postoperative improvement (all P < 0.05). Despite no significant difference in preoperative and improvements in indicators between patients assessed by urinary indicators (all P > 0.05), patients with good DC had lower levels of IPSS (3.00 [1.25–5.00] vs 5.00 [2.00–12.75], P = 0.017) and IPSS-v (0 [0–0] vs 0 [0–9.00], P = 0.016) at the 1^st month postoperatively than patients with reduced DC (Figure 4).

Supplementary Table 24.

Comparison of preoperative quality of life and quality of life improvement assessed by urinary indicators in patients with benign prostatic hyperplasia

	Preoperative QoL			QoL improvement

	Median (IQR)	Z	P	r	OR (95% CI)	P
Reduced DC	5.00 (4.00–6.00)	−1.16	0.286	−1.12	0.33 (0.10–1.06)	0.063
Good DC	5.50 (5.00–6.00)

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CI: confidence interval; OR: odds ratio; DC: detrusor contractility; IQR: interquartile range; QoL: quality of life

Supplementary Table 35.

Analysis of postoperative International Prostate Symptom Score - (voiding) between different detrusor contractility groups

	IPSS-v at the postoperative 1^st month			IPSS-v at the postoperative 6^th month

	Median (IQR)	Z	P	Median (IQR)	Z	P
Reduced DC	0 (0–9.00)	−2.56	0.016	0	−0.41	0.812
Good DC	0			0

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DC: detrusor contractility; IPSS-v: International Prostate Symptom Score (voiding); IQR: interquartile range

Comparison of postoperative indicators, including (a) IPSS, (b) IPSS-v, (c) IPSS-s, and (d) QoL in patients with BPH with good (normal and strong) and reduced (weak and very weak) DC (assessed by urinary BDNF, NGF, and PGE2) at the postoperative 1^st month. ^*P < 0.05. NS: not significant; BDNF: brain-derived neurotrophic factor; BPH: benign prostatic hyperplasia; DC: detrusor contractility; IPSS: International Prostate Symptom Score; IPSS-s: IPSS storage; IPSS-v: IPSS voiding; NGF: nerve growth factor; PGE2: prostaglandin estradiol; QoL: quality of life.

Supplementary Table 25.

Comparison of preoperative International Prostate Symptom Score and International Prostate Symptom Score improvement assessed by urinary indicators in patients with benign prostatic hyperplasia

	Preoperative IPSS			IPSS improvement

	Median (IQR)	Z	P	r	OR (95% CI)	P
Reduced DC	20.50 (14.75–24.25)	−0.09	0.948	−1.21	0.30 (0.03–2.97)	0.302
Good DC	18.50 (16.00–24.00)

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CI: confidence interval; OR: odds ratio; DC: detrusor contractility; IPSS: International Prostate Symptom Score; IQR: interquartile range

Supplementary Table 26.

Comparison of preoperative International Prostate Symptom Score (storage) and International Prostate Symptom Score (storage) improvement assessed by urinary indicators in patients with benign prostatic hyperplasia

	Preoperative IPSS-s			IPSS-s improvement

	Median (IQR)	Z	P	r	OR (95% CI)	P
Reduced DC	9.50 (6.75–11.25)	−0.02	0.983	−0.93	0.39 (0.08–2.05)	0.268
Good DC	10.00 (7.25–11.00)

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CI: confidence interval; OR: odds ratio; DC: detrusor contractility; IPSS-s: International Prostate Symptom Score (storage); IQR: interquartile range

Supplementary Table 27.

Comparison of preoperative International Prostate Symptom Score (voiding) and International Prostate Symptom Score (voiding) improvement assessed by urinary indicators in patients with benign prostatic hyperplasia

	Preoperative IPSS-v			IPSS-v improvement

	Median (IQR)	Z	P	r	OR (95% CI)	P
Reduced DC	11.00 (8.00–13.25)	−0.22	0.846	−1.47	−0.23 (0.02–2.53)	0.230
Good DC	11.00 (7.25–14.00)

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CI: confidence interval; OR: odds ratio; DC: detrusor contractility; IPSS-v: International Prostate Symptom Score (voiding); IQR: interquartile range

Supplementary Table 28.

Analysis of quality of life improvements between in different detrusor contractility groups (vs preoperative)

	Preoperative QoL, median (IQR)	QoL at the postoperative 1^st month			QoL at the postoperative 6^th month

		Median (IQR)	Z	P	Median (IQR)	Z	P
Reduced DC	5.00 (4.00–6.00)	3.00 (1.75–3.50)	−2.63	0.009	1.50 (0.75–2.00)	−2.82	0.005
Good DC	5.50 (5.00–6.00)	2.00 (2.00–3.00)	−3.98	<0.001	1.00 (1.00–2.00)	−3.97	<0.001

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DC: detrusor contractility; IQR: interquartile range; QoL: quality of life

Supplementary Table 29.

Analysis of International Prostate Symptom Score improvements between in different detrusor contractility groups (vs preoperative)

	Preoperative IPSS, median (IQR)	IPSS at the postoperative 1^st month			IPSS at the postoperative 6^th month

		Median (IQR)	Z	P	Median (IQR)	Z	P
Reduced DC	20.50 (14.75–24.25)	5.00 (2.00–12.75)	−2.70	0.007	2.00 (1.00–5.00)	−2.81	0.005
Good DC	18.50 (16.00–24.00)	3.00 (1.25–5.00)	−3.92	<0.001	2.00 (1.00–3.75)	−3.92	<0.001

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DC: detrusor contractility; IPSS: International Prostate Symptom Score; IQR: interquartile range

Supplementary Table 30.

International Prostate Symptom Score (storage) improvements between in different detrusor contractility groups (vs preoperative)

	Preoperative IPSS-s, median (IQR)	IPSS-s at the postoperative 1^st month			IPSS-s at the postoperative 6^th month

		Median (IQR)	Z	P	Median (IQR)	Z	P
Reduced DC	9.50 (6.75–11.25)	3.50 (2.00–7.50)	−2.52	0.012	2.00 (1.00–5.00)	−2.81	0.005
Good DC	10.00 (7.25–11.00)	3.00 (1.25–4.75)	−3.53	<0.001	2.00 (1.00–3.00)	−3.63	<0.001

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DC: detrusor contractility; IPSS-s: International Prostate Symptom Score (storage); IQR: interquartile range

Supplementary Table 31.

International Prostate Symptom Score (voiding) improvements between in different detrusor contractility groups (vs preoperative)

	Preoperative IPSS-v, median (IQR)	IPSS-v at the postoperative 1^st month			IPSS-v at the postoperative 6^th month

		Median (IQR)	Z	P	Median (IQR)	Z	P
Reduced DC	11.00 (8.00–13.25)	0 (0–9.00)	−2.52	0.012	0	−2.82	0.005
Good DC	11.50 (7.25–14.00)	0	−3.93	<0.001	0	−3.93	<0.001

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DC: detrusor contractility; IPSS-v: International Prostate Symptom Score (voiding); IQR: interquartile range

Supplementary Table 32.

Analysis of postoperative quality of life between different detrusor contractility groups

	QoL at the postoperative 1^st month			QoL at the postoperative 6^th month

	Median (IQR)	Z	P	Median (IQR)	Z	P
Reduced DC	3.00 (1.75–3.50)	−1.43	0.164	1.50 (0.75–2.00)	−0.69	0.530
Good DC	2.00 (2.00–3.00)			1.00 (1.00–2.00)

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DC: detrusor contractility; IQR: interquartile range; QoL: quality of life

Supplementary Table 33.

Analysis of postoperative International Prostate Symptom Score between different detrusor contractility groups

	IPSS at the postoperative 1^st month			IPSS at the postoperative 6^th month

	Median (IQR)	Z	P	Median (IQR)	Z	P
Reduced DC	5.00 (2.00–12.75)	−2.53	0.017	2.00 (1.00–5.00)	−0.11	0.914
Good DC	3.00 (1.25–500)			2.00 (1.00–3.75)

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DC: detrusor contractility; IPSS: International Prostate Symptom Score; IQR: interquartile range

Supplementary Table 34.

Analysis of postoperative International Prostate Symptom Score (storage) between different detrusor contractility groups

	IPSS-s at the postoperative 1^st month			IPSS-s at the postoperative 6^th month

	Median (IQR)	Z	P	Median (IQR)	Z	P
Reduced DC	3.50 (2.00–7.50)	−1.380	0.18	2.00 (1.00–5.00)	−0.23	0.846
Good DC	3.00 (1.25–4.75)			2.00 (1.00–3.00)

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DC: detrusor contractility; IPSS-s: International Prostate Symptom Score (storage); IQR: interquartile range

DISCUSSION

The increasing incidence of BPH in middle-aged and elderly people not only affects micturition but also leads to various complications. Long-term oral medications may delay the timing of surgical treatment for patients who are insensitive to drugs, which may lead to deterioration of the bladder. However, as a dysfunctional bladder may cause unsatisfactory outcomes, it is inappropriate to avoid surgeries in patients with impaired bladder function. Therefore, we combined LUTS, imaging, UDS, and urinary indicators to comprehensively evaluate the impact of bladder function on the efficacy of transurethral prostate surgery in patients with BPH.

In the initial stage of micturition, patients with BPH with BOO will exhibit enhanced detrusor contractility to facilitate micturition, which will directly levitate the intravesical pressure. Subsequently, when the intravesical pressure surpasses the pressure of blood vessels in the bladder wall, the bladder will suffer from ischemia and hypoxia, and the decrease in postmicturition intravesical pressure may result in reperfusion injury to the bladder wall. Moreover, periodic ischemia–reperfusion injury can cause hypertrophy in epithelial cells, fibroblasts, and smooth muscle cells, as well as intramural nerve injury and deposition of extracellular matrix, leading to bladder remodeling.17 IPSS-s and IPSS-v can reflect the severity of LUTS in the urine storage and micturition periods and further indicate bladder function. Early studies demonstrated that IPSS was an independent predictor of the efficacy of transurethral prostate surgery, which was confirmed by our findings.18,19 In general, patients in severe groups classified by IPSS-s and IPSS-v might achieve more obvious improvements while still showing high levels of postoperative indicators, which is similar to the findings by Tao et al.20 In the early days after surgery, patients might experience irritative symptoms due to the destruction of epithelium.21 However, after the repairment of urinary tract urothelium, TURP and PVP not only greatly improve the blood circulation and nerve recanalization of the bladder wall,22 which directly reduces irritative symptoms, but also improve PVR and prolong the time of bladder filling, which indirectly reduce the urinary frequency and nocturnal micturition. However, in patients with BPH, LUTS in the micturition period are not only related to the change in detrusor function but also directly related to the degree and duration of BOO. A Japanese study found that patients with BPH with severe preoperative obstruction had better functional recovery in the postoperative micturition period than those with less severe obstruction.23 Therefore, when patients with high IPSS-v are relieved of obstruction by surgery, the remission of IPSS-v should be more significant than that observed in patients with low IPSS-v. Notably, surgical interventions indeed have a remarkable effect on patients with BPH, yet with the aggravation of symptoms, the degree of improvements is limited, suggesting that patients with severe LUTS will still present with relatively high scores. Therefore, patients with BPH should be recommended to undergo surgeries as soon as possible after they have surgical indications given that late treatment may lead to poor recovery.

The UDS contains many indicators reflecting bladder function. Seki et al.24 found that preoperative detrusor contractility was positively correlated with the improvement of postoperative urinary frequency (OR = 3.4, P = 0.01), urgency (OR = 9.5, P = 0.02), and nocturia (OR = 3.0, P = 0.01). In the compensatory period of BPH, hypertrophic and proliferative detrusor muscle cells produce enhanced DC. Moreover, in the decompensation period, the broken and denatured detrusor muscle cells, together with accumulated extracellular fibers, produce a marked decrease in DC, leading to an increase in residual urine. Therefore, it is evident that patients with DU have worse recovery than those who are still in the compensation stage. These findings echo our advocation for early surgical interventions in patients with BPH who meet the indications.

Bladder contractility is manifested as an increase in bladder volume per increment of intravesical pressure when a bladder with good sensation is receptively relaxed as urine filling with inapparent levitation in intravesical pressure. In the rat model, BOO leads to phenotypic transformation in bladder smooth muscle, including a decrease in the contractile phenotype, which is accompanied by decreased DC, increased synthetic phenotype, production of excessive extracellular matrix and cytokines, and results in an obvious decrease in DC and BC.25 Kim et al.26 found that transforming growth factor-beta 1 (TGF-β1) is associated with the severity of BOO, whereas an obvious increase in mRNA expression of TGF-β1 regulates the translation and transcription of collagen, promoting the accumulation of collagen and consequently reducing the BC. Therefore, decreased BC may be related to obvious symptoms and poor recovery, as is validated by our results.

The receptors in the bladder wall are physiologically stimulated by the accumulation of urine, and when the excitement of accumulated urine exceeds the threshold of the receptors, signals pass through the afferent fibers (mainly A-δ fibers) to the cerebral cortex to regulate micturition. Another type of afferent fiber, C fiber, results in hypersensitivity and irritative symptoms when activated by noxious stimulation. And patients will suffer from reduced sensation and urinary retention when the pathway is damaged. Under pathological conditions, a small increase in urine volume could easily lead to bladder sensitivity, and bladder muscle impairments can lead to reduced bladder sensitivity, both of which are confirmed by the results observed in patients with good bladder sensitivity.

In addition to the noninvasive and minimally invasive technologies used in recent years, urinary molecules are gradually emerging as a new biomarker for the evaluation of bladder function in patients with BPH. Specifically, NGF, BDNF, and PGE2 are physiologically produced by smooth muscle and mucosa in the bladder.27 As neurotransmitters, BDNF and NGF are responsible for motor and sensory nerve conduction in the bladder, while PGE2 is derived from fatty acids and is mainly involved in the regulation of afferent neurotransmission and basic tension. Many studies, together with the current study, have found that the levels of BDNF, NGF, and PGE2 increase significantly in the urine of patients with overactive bladder (OAB).28,29 Although no significant differences were identified between urinary levels of BDNF, NGF, and PGE2 in BOO subgroups (BOO positive vs BOO suspicious), when patients were classified by URA, which also reflected the degree of BOO, the urinary levels of BDNF/Cr, NGF/Cr, and PGE2/Cr all showed remarkable differences (all P < 0.05), which is consistent with the conclusion of Yokoyama et al.30 However, no comparison was made between the urinary levels of small molecules in patients with and without BOO. Similarly, increased urinary levels of BDNF/Cr, NGF/Cr, and PGE2/Cr should be identified in patients with sensitive bladders, but the correlations between BS and urinary molecules were poorly validated in this study. Therefore, whether the presence of BOO and bladder sensitivity impact the levels of urinary BDNF/Cr, NGF/Cr, and PGE2/Cr in patients with BPH requires confirmation by further studies.

Vijaya et al.31 stated that the specificity of NGF/Cr to diagnose OAB in female patients was relatively low (39%). However, when we used BDNF/Cr, NGF/Cr, and PGE2/Cr to jointly diagnose DC in patients with BPH, the average weighted AUC (95% CI) was 0.809 (0.647–0.971), and the specificity and sensitivity were 60.00% and 93.30%, respectively. In parallel, patients with good DC, as assessed by urinary molecules, had lower IPSS, IPSS-s, and IPSS-v at the 1^st month postoperatively compared to those with weak DC (all P < 0.05). Hence, the urinary levels of BDNF/Cr, NGF/Cr, and PGE2/Cr in patients with BPH may be valid predictors for the assessment of DC and LUTS at the 1^st month postoperatively.

In terms of imaging data, cellular and matrix hypertrophy/hyperplasia could lead to an increment in PV, as mentioned above, which may also affect the recovery in patients with BPH. However, multiple studies have found that the PV in patients with BPH is not a valid predictor of the diagnosis of BOO or surgical efficacy.32,33 In this study, we observed no significant differences in postoperative indicators between patients with large and small PVs. In general, the larger the PV volume, the more likely BOO will occur. However, BOO will not occur if the prostate does not compress the urethra when PV increases, and BOO may also occur if the small prostate compresses the urethra or bladder neck; this might explain the controversies in the postoperative effects of PVs. Theoretically, PVR might be a predictive factor related to the recovery of patients with BPH. However, intricately influenced by BOO, DC, bladder filling, and nervousness, PVR was not a valid predictor in this study.

This study has several limitations that warrant discussion. The postoperative indicators are subjective and could be greatly affected by the subjective feelings of patients. The longest follow-up was 1 year after surgery, and the number of patients in some subgroups and patients who underwent urinalysis was limited. Nevertheless, it is evident that the urinary indicators (BDNF, NGF, and PGE2) may reflect OAB, BOO, and DC, and even predict the surgical efficacy in patients with BPH. Further clinical studies with larger samples are needed to confirm the roles of these indicators in patients with BPH.

CONCLUSIONS

PVP and TURP can improve the LUTS and QoL in most patients with BPH, while those with impaired bladder functions had poor recovery postoperatively. The urinary levels of BDNF/Cr, NGF/Cr, and PGE2/Cr in patients with BPH were higher than those in healthy participants. Urinary levels of BDNF/Cr, NGF/Cr, and PGE2/Cr may be valid predictors for preoperative bladder function and postoperative recovery in patients with BPH.

AUTHOR CONTRIBUTIONS

JL, JZA, and LRL designed research. BC and YH conducted research. ZYC, DHC, and PZW drew the illustrations. JL, XYLY, and DZL wrote the paper. JZA and LRL supervised the whole research and had primary responsibility for final content. All authors read and approved the final manuscript.

COMPETING INTERESTS

All authors declare no competing interests.

Supplementary Information is linked to the online version of the paper on the Asian Journal of Andrology website.

ACKNOWLEDGMENTS

This study was supported by grants from the National Natural Science Foundation of China (No. 82070784 and No. 81702536) and grants from the Science & Technology Department of Sichuan Province, China (No. 2022JDRC0040 and No. 2020YJ0054).

REFERENCES

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19.Chalise PR, Agrawal CS. Change in urinary symptoms and quality of life in men with benign prostatic hyperplasia after transurethral resection of prostate. Nepal Med Coll J. 2007;9:255–8. [PubMed] [Google Scholar]
20.Tao YC, Wei ZW, Liu C, Gu M, Chen Q, et al. Better timing for HoLEP: a retrospective analysis of patients treated with HoLEP over a 10-year period with a 1-year follow-up. Asian J Androl. 2023;25:281–5. doi: 10.4103/aja202224. [DOI] [PMC free article] [PubMed] [Google Scholar]
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24.Seki N, Yuki K, Takei M, Yamaguchi A, Naito S. Analysis of the prognostic factors for overactive bladder symptoms following surgical treatment in patients with benign prostatic obstruction. Neurourol Urodyn. 2009;28:197–201. doi: 10.1002/nau.20619. [DOI] [PubMed] [Google Scholar]
25.Gong Y, Song B, Jin XY, Xiong EQ. Effect of bladder outlet obstruction on detrusor smooth muscle cell: an in vitro study. J Surg Res. 2003;114:202–9. doi: 10.1016/s0022-4804(03)00333-0. [DOI] [PubMed] [Google Scholar]
26.Kim JC, Seo SI, Park YH, Hwang TK. Changes in detrusor and urinary growth factors according to detrusor function after partial bladder outlet obstruction in the rat. Urology. 2001;57:371–5. doi: 10.1016/s0090-4295(00)00886-4. [DOI] [PubMed] [Google Scholar]
27.Cruz CD. Neurotrophins in bladder function: what do we know and where do we go from here? Neurourol Urodynam. 2014;33:39–45. doi: 10.1002/nau.22438. [DOI] [PubMed] [Google Scholar]
28.Tsiapakidou S, Apostolidis A, Pantazis K, Grimbizis GF, Mikos T. The use of urinary biomarkers in the diagnosis of overactive bladder in female patients. A systematic review and meta-analysis. Int Urogynecol J. 2021;32:3143–55. doi: 10.1007/s00192-021-04945-1. [DOI] [PubMed] [Google Scholar]
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31.Vijaya G, Cartwright R, Bhide A, Derpapas A, Fernando R, et al. Reliability and validity of urinary nerve growth factor measurement in women with lower urinary tract symptoms. Neurourol Urodynam. 2016;35:944–8. doi: 10.1002/nau.22832. [DOI] [PubMed] [Google Scholar]
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[R1] 1.Guo R, Yu W, Zhang K, Xu B. Impact of changing trends in medical therapy on transurethral resection of the prostate: two decades of change in China. Urology. 2016;92:80–6. doi: 10.1016/j.urology.2016.01.027. [DOI] [PubMed] [Google Scholar]

[R2] 2.Paick JS, Um JM, Kwak C, Kim SW, Ku JH. Influence of bladder contractility on short-term outcomes of high-power potassium-titanyl-phosphate photoselective vaporization of the prostate. Urology. 2007;69:859–63. doi: 10.1016/j.urology.2007.01.042. [DOI] [PubMed] [Google Scholar]

[R3] 3.Cho MC, Ha SB, Park J, Son H, Oh SJ, et al. Impact of detrusor underactivity on surgical outcomes of laser prostatectomy: comparison in serial 12-month follow-up outcomes between potassium-titanyl-phosphate photoselective vaporization of the prostate (PVP) and holmium laser enucleation of the prostate (HoLEP) Urology. 2016;91:158–66. doi: 10.1016/j.urology.2015.11.052. [DOI] [PubMed] [Google Scholar]

[R4] 4.Blaivas JG, Forde JC, Davila JL, Policastro L, Tyler M, et al. Surgical treatment of detrusor underactivity: a short term proof of concept study. Int Braz J Urol. 2017;43:540–8. doi: 10.1590/S1677-5538.IBJU.2016.0405. [DOI] [PMC free article] [PubMed] [Google Scholar]

[R5] 5.Munoz A, Smith CP, Boone TB, Somogyi GT. Overactive and underactive bladder dysfunction is reflected by alterations in urothelial ATP and NO release. Neurochem Int. 2011;58:295–300. doi: 10.1016/j.neuint.2010.12.002. [DOI] [PMC free article] [PubMed] [Google Scholar]

[R6] 6.Lerner LB, McVary KT, Barry MJ, Bixler BR, Dahm P, et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA GUIDELINE PART II-surgical evaluation and treatment. J Urol. 2021;206:818–26. doi: 10.1097/JU.0000000000002184. [DOI] [PubMed] [Google Scholar]

[R7] 7.Liao CH, Chung SD, Kuo HC. Diagnostic value of International Prostate Symptom Score voiding-to-storage subscore ratio in male lower urinary tract symptoms. Int J Clin Pract. 2011;65:552–8. doi: 10.1111/j.1742-1241.2011.02638.x. [DOI] [PubMed] [Google Scholar]

[R8] 8.Eri LM, Thomassen H, Brennhovd B, Haheim LL. Accuracy and repeatability of prostate volume measurements by transrectal ultrasound. Prostate Cancer Prostatic Dis. 2002;5:273–8. doi: 10.1038/sj.pcan.4500568. [DOI] [PubMed] [Google Scholar]

[R9] 9.Bih LI, Ho CC, Tsai SJ, Lai YC, Chow W. Bladder shape impact on the accuracy of ultrasonic estimation of bladder volume. Arch Phys Med Rehabil. 1998;79:1553–6. doi: 10.1016/s0003-9993(98)90419-1. [DOI] [PubMed] [Google Scholar]

[R10] 10.Semjonow A, Hamm M, Rathert P, Hertle L. Prostate-specific antigen corrected for prostate volume improves differentiation of benign prostatic hyperplasia and organ-confined prostatic cancer. Br J Urol. 1994;73:538–43. doi: 10.1111/j.1464-410x.1994.tb07640.x. [DOI] [PubMed] [Google Scholar]

[R11] 11.Schafer W, Abrams P, Liao L, Mattiasson A, Pesce F, et al. Good urodynamic practices: uroflowmetry, filling cystometry, and pressure-flow studies. Neurourol Urodyn. 2002;21:261–74. doi: 10.1002/nau.10066. [DOI] [PubMed] [Google Scholar]

[R12] 12.Lim CS, Abrams P. The Abrams-Griffiths nomogram. World J Urol. 1995;13:34–9. doi: 10.1007/BF00182664. [DOI] [PubMed] [Google Scholar]

[R13] 13.Su J, Jogamoto A, Yang LJ, Yoshimura H. Comparison of subjective menopausal symptoms between Chinese and Japanese women: a canonical correlation analysis between severity of subjective symptoms and self-efficacy scores. Menopause. 2013;20:1355. [Google Scholar]

[R14] 14.Medina Lucena H, Tincello DG. Methods of assessing and recording bladder sensation: a review of the literature. Int Urogynecol J. 2019;30:3–8. doi: 10.1007/s00192-018-3760-x. [DOI] [PMC free article] [PubMed] [Google Scholar]

[R15] 15.Abrams P. Bladder outlet obstruction index, bladder contractility index and bladder voiding efficiency: three simple indices to define bladder voiding function. BJU Int. 1999;84:14–5. doi: 10.1046/j.1464-410x.1999.00121.x. [DOI] [PubMed] [Google Scholar]

[R16] 16.Eckhardt MD, van Venrooij GE, Boon TA. Urethral resistance factor (URA) versus Schafer's obstruction grade and Abrams-Griffiths (AG) number in the diagnosis of obstructive benign prostatic hyperplasia. Neurourol Urodyn. 2001;20:175–85. doi: 10.1002/1520-6777(2001)20:2<175::aid-nau20>3.0.co;2-t. [DOI] [PubMed] [Google Scholar]

[R17] 17.Eddinger TJ. Reversible plasticity of detrusor smooth muscle: evidence for a key role of “slipping” actomyosin cross-bridges in the control of urinary bladder compliance. Am J Physiol Renal Physiol. 2017;313:F862–3. doi: 10.1152/ajprenal.00227.2017. [DOI] [PubMed] [Google Scholar]

[R18] 18.Hossain MA, Alam MA, Naser MF, Azam MS. Effects of transurethral resection of prostate (TURP) on quality of life in case of benign prostatic hyperplasia. J Natl Inst Neurosci Bangladesh. 2019;5:143–7. [Google Scholar]

[R19] 19.Chalise PR, Agrawal CS. Change in urinary symptoms and quality of life in men with benign prostatic hyperplasia after transurethral resection of prostate. Nepal Med Coll J. 2007;9:255–8. [PubMed] [Google Scholar]

[R20] 20.Tao YC, Wei ZW, Liu C, Gu M, Chen Q, et al. Better timing for HoLEP: a retrospective analysis of patients treated with HoLEP over a 10-year period with a 1-year follow-up. Asian J Androl. 2023;25:281–5. doi: 10.4103/aja202224. [DOI] [PMC free article] [PubMed] [Google Scholar]

[R21] 21.Zhang H, Tian Y, Yang B, An LY, Xia SJ, et al. A novel mouse model simulating transurethral laser vaporization prostatectomy. Asian J Androl. 2022;24:191–4. doi: 10.4103/aja.aja_59_21. [DOI] [PMC free article] [PubMed] [Google Scholar]

[R22] 22.Saito K, Hisasue S, Ide H, Aoki H, Muto S, et al. The impact of increased bladder blood flow on storage symptoms after holmium laser enucleation of the prostate. PLoS One. 2015;10:e0129111. doi: 10.1371/journal.pone.0129111. [DOI] [PMC free article] [PubMed] [Google Scholar]

[R23] 23.Tanaka Y, Masumori N, Itoh N, Furuya S, Ogura H, et al. Is the short-term outcome of transurethral resection of the prostate affected by preoperative degree of bladder outlet obstruction, status of detrusor contractility or detrusor overactivity? Int J Urol. 2006;13:1398–404. doi: 10.1111/j.1442-2042.2006.01589.x. [DOI] [PubMed] [Google Scholar]

[R24] 24.Seki N, Yuki K, Takei M, Yamaguchi A, Naito S. Analysis of the prognostic factors for overactive bladder symptoms following surgical treatment in patients with benign prostatic obstruction. Neurourol Urodyn. 2009;28:197–201. doi: 10.1002/nau.20619. [DOI] [PubMed] [Google Scholar]

[R25] 25.Gong Y, Song B, Jin XY, Xiong EQ. Effect of bladder outlet obstruction on detrusor smooth muscle cell: an in vitro study. J Surg Res. 2003;114:202–9. doi: 10.1016/s0022-4804(03)00333-0. [DOI] [PubMed] [Google Scholar]

[R26] 26.Kim JC, Seo SI, Park YH, Hwang TK. Changes in detrusor and urinary growth factors according to detrusor function after partial bladder outlet obstruction in the rat. Urology. 2001;57:371–5. doi: 10.1016/s0090-4295(00)00886-4. [DOI] [PubMed] [Google Scholar]

[R27] 27.Cruz CD. Neurotrophins in bladder function: what do we know and where do we go from here? Neurourol Urodynam. 2014;33:39–45. doi: 10.1002/nau.22438. [DOI] [PubMed] [Google Scholar]

[R28] 28.Tsiapakidou S, Apostolidis A, Pantazis K, Grimbizis GF, Mikos T. The use of urinary biomarkers in the diagnosis of overactive bladder in female patients. A systematic review and meta-analysis. Int Urogynecol J. 2021;32:3143–55. doi: 10.1007/s00192-021-04945-1. [DOI] [PubMed] [Google Scholar]

[R29] 29.Wrobel A, Kluz T, Surkont G, Wlazlak E, Skorupski P, et al. Novel biomarkers of overactive bladder syndrome. Ginekol Pol. 2017;88:568–73. doi: 10.5603/GP.a2017.0102. [DOI] [PubMed] [Google Scholar]

[R30] 30.Yokoyama T, Kumon H, Nagai A. Correlation of urinary nerve growth factor level with pathogenesis of overactive bladder. Neurourol Urodynam. 2008;27:417–20. doi: 10.1002/nau.20519. [DOI] [PubMed] [Google Scholar]

[R31] 31.Vijaya G, Cartwright R, Bhide A, Derpapas A, Fernando R, et al. Reliability and validity of urinary nerve growth factor measurement in women with lower urinary tract symptoms. Neurourol Urodynam. 2016;35:944–8. doi: 10.1002/nau.22832. [DOI] [PubMed] [Google Scholar]

[R32] 32.Singh K, Sinha RJ, Sokhal A, Singh V. Does prostate size predict the urodynamic characteristics and clinical outcomes in benign prostate hyperplasia. Urol Ann. 2017;9:223–9. doi: 10.4103/0974-7796.210029. [DOI] [PMC free article] [PubMed] [Google Scholar]

[R33] 33.Kim M, Cheeti A, Yoo C, Choo M, Paick JS, et al. Non-invasive clinical parameters for the prediction of urodynamic bladder outlet obstruction: analysis using causal Bayesian networks. PLoS One. 2014;9:e113131. doi: 10.1371/journal.pone.0113131. [DOI] [PMC free article] [PubMed] [Google Scholar]

PERMALINK

The effect of bladder function on the efficacy of transurethral prostatectomy in patients with benign prostatic hyperplasia: a retrospective, single-center study

Jin Li

Xian-Yan-Ling Yi

Ze-Yu Chen

Bo Chen

Yin Huang

Da-Zhou Liao

Pu-Ze Wang

De-Hong Cao

Jian-Zhong Ai

Liang-Ren Liu

Abstract

INTRODUCTION

PARTICIPANTS AND METHODS

Patients and healthy participants

Methods

Supplementary Table 1.

RESULTS

Table 1.

Supplementary Table 2.

Supplementary Table 3.

Supplementary Table 5.

Supplementary Table 6.

Supplementary Table 9.

Supplementary Table 17.

Supplementary Table 4.

Supplementary Table 7.

Supplementary Table 8.

Supplementary Table 10.

Supplementary Table 11.

Supplementary Table 12.

Supplementary Table 13.

Supplementary Table 14.

Supplementary Table 15.

Supplementary Table 16.

Influence of preoperative LUTS on surgical outcomes in patients with BPH

Influence of imaging data on surgical outcomes in patients with BPH

Influence of UDS on surgical outcomes in patients with BPH

Influence of urinary indicators and surgical outcomes in patients with BPH

Table 2.

Figure 1.

Supplementary Table 18.

Supplementary Table 19.

Figure 2.

Figure 3.

Supplementary Table 20.

Supplementary Table 22.

Supplementary Table 23.

Supplementary Table 21.

Supplementary Table 24.

Supplementary Table 35.

Figure 4.

Supplementary Table 25.

Supplementary Table 26.

Supplementary Table 27.

Supplementary Table 28.

Supplementary Table 29.

Supplementary Table 30.

Supplementary Table 31.

Supplementary Table 32.

Supplementary Table 33.

Supplementary Table 34.

DISCUSSION

CONCLUSIONS

AUTHOR CONTRIBUTIONS

COMPETING INTERESTS

ACKNOWLEDGMENTS

REFERENCES

ACTIONS

PERMALINK

RESOURCES

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