Objective: To critically evaluate contemporary evidence regarding the outcomes of bladder outlet deobstructive surgery in men with urodynamically confirmed detrusor underactivity (DUA), focusing on functional, urodynamic, and patient-reported outcomes following transurethral resection of the prostate (TURP), holmium laser enucleation (HoLEP), and photoselective vaporization of the prostate (PVP).

Methods: An integrative review was conducted using PubMed, Embase, and SciELO databases to identify studies published between January 2017 and March 2024. Eligible studies included adult men with urodynamically confirmed DUA undergoing surgical treatment for benign prostatic obstruction (BPO). Outcomes of interest included International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), postvoid residual volume (PVR), and validated quality-of-life (QoL) measures. Prospective and retrospective cohort studies, systematic reviews, and meta-analyses were included. Due to methodological heterogeneity, findings were synthesized narratively.

Results: Across the included studies, patients presented with severe baseline dysfunction, including high symptom burden, markedly reduced urinary flow, and elevated PVR volumes. Following outlet deobstruction, consistent and clinically meaningful improvements were observed. IPSS decreased by approximately 50–60%, with postoperative scores frequently reaching mild-to-moderate symptom ranges. Qmax nearly doubled in most studies, while PVR decreased by more than 60% on average. Subjective QoL improvement was reported in 80–85% of patients. Although a subset of men with severe detrusor impairment remained dependent on intermittent catheterization, many experienced reductions in catheterization frequency and improved voiding efficiency. Meta-analyses confirmed the reproducibility of these benefits across different surgical modalities.

Conclusion: Bladder outlet deobstructive surgery may provide substantial symptomatic, functional, and quality-of-life benefits in men with DUA, despite impaired detrusor contractility. These findings challenge the traditional assumption that DUA predicts poor surgical outcomes and support a more individualized, urodynamics-based approach to patient selection and counseling. In this population, reduction of outlet resistance appears to play a more decisive role in postoperative improvement than detrusor strength alone.