Selected Patients with Benign Prostatic Enlargement and Detrusor Underactivity may Benefit from Prostate Surgery: An Exploratory Study

OBJECTIVE: To evaluate non-invasive biomarkers of detrusor underactivity (DU) in men with benign prostatic enlargement (BPE) and their ability to predict clinical and urodynamic improvement following prostate surgery. Particular attention was given to urinary adenosine triphosphate (ATP) levels, bladder contractility index (BCI), and bladder voiding efficiency (BVE). METHODS: This exploratory study included 24 men with BPE undergoing prostate surgery. Based on pre-operative pressure-flow studies (P/F studies), patients were divided into DU (BCI < 100) and non-DU (BCI ≥ 100) groups. Urinary ATP levels were compared among DU patients, non-DU patients, and age-matched healthy male volunteers. Clinical and urodynamic parameters, including BCI and BVE, were assessed before and 1 year after surgery. RESULTS: Thirteen patients were classified as DU, and 11 as non-DU. Median urinary ATP levels did not differ between groups. One year after surgery, DU patients presented a significant improvement in International Prostate Symptom Score, quality of life, Qmax, and post-void residual volume. However, median BCI did not increase after surgery. Apart from BCI, all other parameters were similar between groups after surgery. In this cohort, all DU patients with a pre-operative BVE > 40% achieved surgical success, compared to <50% of those with BVE < 40%. CONCLUSION: Urinary ATP does not appear to be a useful DU biomarker in men with BPE. Although prostate surgery did not significantly improve detrusor function 1 year after surgery, most DU patients experienced clinical improvement. Pre-operative BVE seems a simple non-invasive tool to identify DU patients more likely to benefit from surgery. Cite this article as: Vale L, Charrua A, Silva CM, Teixeira AA, Cruz F, Antunes-Lopes T. Selected patients with benign prostatic enlargement and detrusor underactivity may benefit from prostate surgery: an exploratory study. Urol Res Pract. 2026, 52, 0005, doi: 10.5152/tud.2026.26005.