Management of prolonged post-operative pelvic pain after transurethral prostate surgery: a clinical real-world survey and international comparison of therapy regimens

Up to 50% of patients with benign prostate hyperplasia (BPH) face post-operative complications after transurethral prostate Surgery. This includes nearly 15% of patients suffering from prolonged post-operative pelvic pain (pPPP) consisting of dysuria and prostatodynia for sometimes several months post-surgery. This study elucidates and proposes a definition of the multi-dimensional nature of prolonged post-operative pelvic pain (pPPP) after transurethral prostate surgery by providing real-world data on therapeutic options and their efficacy. German and international urologic practitioners participated in an online-survey after invitation via social media accounts and newsletters. The survey included questions on the amount of expertise, the therapeutic regimens for prolonged post-operative pelvic pain (pPPP) and the expected therapy outcome. Participation was voluntary and uncompensated. Chi-Square tests and Student's t-tests were used for descriptive statistics. 67 German urologists participated in a 9-question online Survey. 94,0% treated patients with lower urinary tract symptoms and 85,1% disclosed their therapeutic regime for prolonged post-operative pelvic pain (pPPP). The most common treatments included anti-inflammatory medication (69,6%), anti-cholinergics (53,6%), alpha-blockers (51,8%) and pelvic physiotherapy (50,0%). Over half of the patients responded to the therapeutic approach, but only 5,4% of urologists anticipated full pain relief after one year. These findings are closely aligned with a recent international survey (n=230). Notably, German urologists more frequently prescribed anti-cholinergics (53,6% vs. 28,7%, p = 0,0004), herbal remedies like saw palmetto (25,0% vs. 6,5%, p < 0,0001) and non-pharmacological therapies (82,1% vs. 49,1%, p < 0,0001), but less anti-inflammatory drugs (69,6% vs. 88,7%, p = 0,0003), gabapentin/pregabalin (8,9% vs. 42,2%, p < 0,0001) and opioids (0% vs 5,7%, p = 0,0221). Based on these results a structured definition and therapy plan for prolonged post-operative pelvic pain (pPPP) is proposed. Prolonged post-operative pelvic pain (pPPP) is a common challenge for urologists. Despite various therapeutic options, treatment outcomes and practitioner confidence remain suboptimal. Further research and attention to prolonged post-operative pelvic pain (pPPP) are essential to develop evidence-based guidelines for effective patient management and prevention of chronic pain syndromes.