# Autonomic Modulation and Symptomatic Efficacy of Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia

## TL;DR

This study shows that prostate surgery improves urinary symptoms and autonomic nervous system function, with heart rate variability as a potential biomarker.

## Contribution

This is the first study to correlate heart rate variability with specific urinary symptom domains before and after prostate surgery.

## Key findings

- Heart rate variability (HRV) improved after surgery, suggesting better autonomic function.
- Urinary symptoms and quality of life significantly improved three months post-surgery.
- HRV correlated inversely with symptom severity, indicating biomarker potential.

## Abstract

Background: Benign Prostatic Hyperplasia (BPH) causes Lower Urinary Tract Symptoms (LUTS), impairing quality of life (QoL). Transurethral Resection of the Prostate (TURP) is the gold-standard surgical treatment for Bladder Outlet Obstruction (BOO), but its effects on Autonomic Nervous System (ANS) function—assessed via Heart Rate Variability (HRV)—remains underexplored. To our knowledge, this is the first study to correlate HRV with specific LUTS domains pre- and post-TURP, establishing HRV as a potential biomarker for BPH management. Methods: In a prospective study, 242 men with BPH underwent TURP (2018–2024). Inclusion required age ≥ 50 years, International Prostate Symptom Score (IPSS) ≥ 8, and BOO evidence. HRV (Standard Deviation of Normal-to-Normal Intervals [SDNN], Low-Frequency/High-Frequency [LF/HF] ratio), IPSS, and QoL were assessed preoperatively and 3 months postoperatively. Paired t-tests, Pearson correlations, and multivariate regression (adjusted for age, Body Mass Index [BMI], prostate volume) were used (p < 0.05). Results: HRV (SDNN) increased from 36.97 ± 22.80 ms to 51.67 ± 27.59 ms (p = 0.032), and LF/HF ratio decreased from 1.63 ± 1.60 to 0.73 ± 0.52 (p = 0.028). IPSS fell from 18.5 ± 6.2 to 8.3 ± 4.1 (p < 0.001), with improved voiding (p = 0.004) and storage (p = 0.002) subscores. QoL improved from 3.5 ± 1.2 to 1.8 ± 0.9 (p = 0.003). HRV correlated inversely with IPSS voiding (r = −0.42, p = 0.012; r = −0.38, p = 0.019 post-TURP) and storage subscores (r = −0.29, p = 0.045). Older patients (≥65 years) and those with larger prostates (≥50 mL) showed greater improvements. Conclusions: TURP enhances LUTS, QoL, and ANS function. HRV’s correlation with LUTS suggests its biomarker potential, with possible cardiovascular benefits. Longitudinal studies are needed.