Concomitant benign prostatic enlargement and bladder stone surgery versus bladder stone treatment alone: results from a systematic review and meta-analysis of comparative studies by the EAU endourology section.

PURPOSE: Men with benign prostatic enlargement (BPE) frequently present with concomitant bladder stones (BS), yet the optimal surgical strategy remains debated. This systematic review and meta-analysis aimed to compare perioperative and postoperative outcomes of concomitant BPE/BS surgery against BS treatment alone.

METHODS

Following the 2020 PRISMA framework, a comprehensive search was conducted on 9 March 2026. Binary outcomes were pooled using the Cochran-Mantel-Haenszel method and reported as odds ratios (OR) with 95% confidence intervals (CI). Continuous outcomes were assessed using inverse variance with 95% CI. Risk of bias was assessed with RoB 2 and ROBINS-I.

RESULTS

Seven comparative studies involving over 500 patients were included. Quality assessment revealed some concerns in the overall risk of bias for the single randomized trial, while non-randomized studies showed moderate (3 studies) and high overall risk of bias (3 studies). Concomitant surgery was associated with a significantly lower odds of BS recurrence (OR 0.18, 95% CI 0.10-0.33, p < 0.00001) and better urinary symptoms at last follow-up (mean IPSS difference - 3.09 points, p < 0.00001) compared with BS surgery alone. Minor complications (Clavien 1-2) were more frequent in the concomitant surgery group (OR 4.35, p < 0.0001), while major complications and stone-free rates did not differ significantly, though the comparison was likely underpowered for major complications. The rate of subsequent BPE surgical procedure in patients who had BS surgery alone ranged from 10% to 41%.

CONCLUSION

Concomitant BPE and BS surgery substantially reduces stone recurrence and improves lower urinary tract symptoms without meaningfully increasing serious perioperative risk, supporting its adoption in selected cases when BS is related to BPE with bladder outlet obstruction.