The link between overactive bladder and benign prostatic obstruction was the focus of a dedicated session at this year’s European Association of Urology 2025 Annual Congress
Overactive bladder (OAB) is defined by the International Continence Society as urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary tract infection or other obvious pathology.
One-in-six adults in Europe suffer from OAB, making it a frequent and disabling disorder.
The link between OAB and benign pros- tatic obstruction (BPO) was the theme of the Plenary Session during the recent European Association of Urology (EAU) 2025 Annual Congress in Madrid, Spain, which took place from 21-24 March.
The session ‘Navigating the urge: Clinical decision-making in patients in OAB and BPO’ was led by Chairs Prof Cosimo De Nunzio and Prof Christian Gratzke.
It kicked off with the Confederación Americana de Urología presentation, ‘Non-invasive work-up of male OAB,’ by Prof Márcio Augusto Averbeck. He presented a case of a 64-year-old patient with mixed lower urinary tract symptoms (LUTS), who had been diagnosed with benign prostate enlargement (BPE) 10 years earlier. With a comorbidity of systemic arterial hypertension, the patient’s most bothersome symptom was urinary urgency. The key question was: What is the non-invasive work-up for a patient with both BPE and OAB symptoms? Prof Averbeck cited the EAU Guidelines on non-neurogenic male LUTS and focused on the recommendations regarding medical history, questionnaires (eg, validated symptom score questionnaire), bladder diaries, physical examination, urinalysis, PSA testing, post-void residual measurement, uroflowmetry, and urethrocystoscopy. He also covered urodynamics and other non-invasive assessments.
Link between BPO and OAB
In his state-of-the-art lecture ‘What is the relationship between BPO and OAB? Separating truth from tradition’, Prof Marcus Drake stated, “Does a voiding phase problem affect the storage phase? The jury is still out. We should be careful not to assume that male LUTS is a dustbin of uniform problems that can be solved with the same interventions.” He added that induction is difficult to support epidemiologically or pathophysiologically. Regarding maintenance, individual post-op outcomes might suggest a connection, but not in cases where baseline parameters are moderate-to-severe.
In addition, Prof Drake said that ‘secondary’ OAB is not a justified reason for performing surgery to relieve BPO; it can only be surmised post-operatively. He stressed the importance of proper assessment and appropriate counselling regarding uncertainty.
Suitable surgery
During the state-of-the-art lecture, ‘Which surgery is best for BPO/OAB patients?’, Associate Prof Malte Rieken concluded that different surgical techniques are associated with varying degrees of de-obstruction. He stated: “In the majority of patients, de-obstruction improves OAB symptoms and detrusor overactivity (DO). If you look at the various technologies, we have established that endoscopic enucleation is the only size-independent surgical technique that offers both obstruction and DO relief. However, there is no one-size-fits-all surgery for BPO/OAB patients, as various factors influence treatment decisions, and we must take patients’ preferences and expectations into account.” Prof Rieken add- ed that high-level evidence specific to the BPO/OAB population is still lacking.
Patient collaboration
To conclude the Plenary Session, Prof Kari Tikkinen presented on the topic of patients’ values and preferences, and underscored the importance of practising proper shared decision-making with accurate information. “Talk to your patients. You need to ask what’s important to them. That’s personalised LUTS management,” stated Prof Tikkinen.
In addition, he stressed: “Patients need to receive accurate information. Studies should report honest results in a manner that is easy to understand. We need to know our results better.”
Regarding key information about prognosis and management, Prof Tikkinen emphasised: “You need to discuss with your patients the risks of not being able to void post-surgery or the potential need for catheterisation. You must inform your patients about which symptoms are more or less likely to resolve. Understanding their prognosis is crucial for decision-making. Talk to them not only about pain, but also about erection, ejaculation, continence, and peri-operative risks.
“There are no brave urologists, only brave patients. At the end of the day, the patient decides whether the urologist did a good job or not,” Prof Tikkinen concluded.
Webcasts, videos, posters, and full text abstracts from the EAU 2025 Annual Congress are accessible via the EAU25 Resource Centre at https://urosource. uroweb.org/resource-centres/EAU25/
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