Transurethral resection of the prostate (TURP) is a well-established surgical intervention for benign prostatic hyperplasia (BPH) and its associated lower urinary tract symptoms (LUTS). While the efficacy of TURP in alleviating voiding dysfunction is well-documented, emerging evidence suggests a significant interplay between BPH/LUTS and the autonomic nervous system (ANS), with TURP potentially influencing autonomic function. This study prospectively investigated the impact of TURP on heart rate variability (HRV) parameters, specifically the low-frequency to high-frequency (LF/HF) ratio, as well as symptomatic relief measured by the International Prostate Symptom Score (IPSS) and its subdomains.

A prospective cohort of 242 male patients diagnosed with symptomatic BPH undergoing TURP at a tertiary medical center between July 2016 and June 2024 was evaluated. Pre- and postoperative assessments (at 3 months) included time-domain analysis of HRV (quantified in milliseconds), frequency domain analysis represented by the LF/HF ratio (an indicator of sympathovagal balance), and the IPSS, encompassing total score, storage and voiding subscores, and quality of life (QoL) index. Statistical significance of changes from baseline to follow-up was determined using paired t-tests with a significance threshold of p<0.05. Correlation analyses were performed to assess the relationship between changes in HRV parameters and IPSS outcomes.

Following TURP, a statistically significant increase in HRV was observed (36.97 ± 22.80 ms to 51.67 ± 27.59 ms, p<0.05), accompanied by a significant reduction in the LF/HF ratio (1.63 ± 1.6 to 0.73 ± 0.52, p<0.05), suggesting a shift towards enhanced autonomic modulation and stability. Clinically, patients experienced substantial symptomatic improvement, with the IPSS total score decreasing significantly from 18.5 ± 6.2 to 8.3 ± 4.1 (p<0.001). Subscore analysis revealed significant reductions in both storage (6.2 ± 2.1 to 3.1 ± 1.8, p<0.01) and voiding (12.3 ± 4.5 to 5.2 ± 3.2, p<0.01) domains, along with a significant enhancement in QoL (3.5 ± 1.2 to 1.8 ± 0.9, p<0.01). However, no significant correlations were found between the improvement in IPSS total or subscores and the changes in HRV parameters (p>0.05).

TURP demonstrates a significant dual benefit in patients with BPH-related LUTS by not only providing robust symptomatic relief and improving quality of life but also by favorably modulating autonomic nervous system activity, as evidenced by increased HRV and a reduced LF/HF ratio. These findings highlight the broader physiological impact of TURP, potentially extending to cardiovascular homeostasis. Further longitudinal studies are warranted to elucidate the underlying mechanisms and long-term durability of these autonomic changes in the context of BPH management.