Benign prostatic obstruction (BPO) is one of the most common causes of bladder outlet obstruction (BOO) and may lead to progressive structural and functional alterations in the bladder over time. Prolonged obstruction triggers a bladder remodeling process characterized by detrusor hypertrophy, ischemia-reperfusion injury, smooth muscle loss, and progressive fibrosis. These pathological changes may result in impaired detrusor contractility, increased post-void residual volume, and suboptimal functional recovery following surgical treatment.

Connective tissue growth factor (CTGF) is a matricellular protein that plays a key role in fibrogenesis and is markedly upregulated under hypoxic, ischemia-reperfusion, and inflammatory conditions. Experimental and cellular studies have demonstrated that CTGF promotes fibroblast proliferation, extracellular matrix production, and collagen deposition, thereby contributing to bladder fibrosis. Increased CTGF expression has also been associated with fibrotic differentiation of bladder smooth muscle cells.

The aim of this observational study is to evaluate the relationship between urinary CTGF levels, bladder fibrosis, and functional response to surgical treatment in patients with benign prostatic obstruction. Preoperative urinary CTGF levels will be assessed and correlated with postoperative functional outcomes and clinical improvement. This study aims to determine whether urinary CTGF may serve as a non-invasive biomarker of bladder fibrosis and a potential predictor of surgical treatment response in patients with BPO.

Inclusion Criteria:

Male patients aged > 40 years

• Diagnosis of benign prostatic obstruction (BPO), with or without an indwelling catheter
• Patients with an indication for surgical treatment according to EAU guidelines

Exclusion Criteria:

• Age < 40 years
• Female sex
• Prostate-specific antigen (PSA) > 2.5 ng/mL
• History of endoscopic urological intervention
• Previous urogenital malignancy or urological surgery
• Diabetes mellitus
• Urethral stricture
• History of pelvic radiotherapy and/or chemotherapy
• Patients performing clean intermittent catheterization
• Neurological diseases causing secondary urinary symptoms (e.g., spinal cord injury, stroke, multiple sclerosis, Parkinson's disease)
• History of spinal surgery
• History of colorectal cancer or previous colorectal surgery

This study includes male patients older than 40 years with a diagnosis of benign prostatic obstruction (BPO) who have an indication for surgical treatment according to European Association of Urology (EAU) guidelines. Eligible patients may be catheterized or non-catheterized at the time of enrollment. Patients with conditions that may affect bladder function or connective tissue metabolism, including neurological diseases, diabetes mellitus, prior urogenital malignancy or surgery, urethral stricture, or previous pelvic radiotherapy or chemotherapy, are excluded.