When you clean up WSUS, do each one separatey if you haven"t cleaned up WSUs in a long time. Don't try to run all of them at the same time.
I don't think Microsoft could have made the wording on that page any more confusing if they tried.
Let's take the first one:
"Delete updates that are expired and have not been approved for 30 days or more"
Does that mean updates that have been specifically declined ONLY or ones that have been specifically approved ONLY or ones that have been specifically declined AND ones that have neither been specifically approved OR declined or ones that have been specifically approved AND ones that have neither been specifically approved OR declined ?
Then the forth one:
"Decline updates that aren't approved and have been expired by Microsoft. "
Do they really mean DECLINE or do they mean DELETE ? To me DECLINE is not going to clean up anything.
The same with the last one. Do they mean DECLINE or DELETE ?
There is no way from looking at the settings on that screen to know for sure what is going to be deleted and what is going to be kept.