Changes in Bladder Outlet Obstruction After Photoselective Vaporization of the Prostate in Men With and Without Detrusor Underactivity: A Retrospective Propensity Score‐Matched Study

OBJECTIVES: To compare symptomatic improvement after photoselective vaporization of the prostate (PVP) between patients with and without detrusor underactivity (DU), together with objective changes in urodynamic parameters assessed by pressure-flow study (PFS). METHODS: This single-center retrospective study evaluated 136 benign prostatic hyperplasia (BPH) patients treated with a 180 W PVP-XPS system from 2020 through 2025. The patients were divided into DU and non-DU groups based on the bladder contractility index (BCI), with DU defined as BCI < 100. We retrospectively analyzed selected patients with BPH and clinically or urodynamically relevant bladder outlet obstruction (BOO) who underwent PVP and completed PFS before and 6 months after surgery. Propensity score matching (PSM) was applied to adjust for age and the baseline BOO index (BOOI). RESULTS: A total of 105 patients were included in the final analysis and 53 were in the DU group. The DU group had a significantly lower BOOI (48.6 ± 17.5 vs. 71.4 ± 32.3, p < 0.01) than the non-DU group. After PSM, age and baseline BOOI were well balanced, but BCI remained significantly different. No significant differences between the two groups were observed in questionnaire scores or uroflowmetry findings at 6 months after surgery. The BOOI at 6 months after surgery was not significantly different between the DU group (13.4 ± 13.7) and the non-DU group (13.7 ± 19.3) (p = 0.93). BOOI reduction was also not significantly different between the DU group (-37.0 ± 24.1) and the non-DU group (-36.2 ± 24.5) (p = 0.90). CONCLUSION: In selected patients with clinically or urodynamically relevant BOO, significant improvements in BOOI and LUTS were observed in patients with DU after PVP, with no statistically significant between-group differences detected at 6 months.