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Transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement: a quality and meta-analysis.

Lee SW, Choi JB, Lee KS, Kim TH, Son H, Jung TY, Oh SJ, Jeong HJ, Bae JH, Lee YS, Kim JC - Int Neurourol J (2013)

Bottom Line: The intraoperative complications of the minimally invasive surgeries had no statistically significant inferior outcomes compared with TURP.Also, there were no statistically significant differences in any of the modalities compared with TURP.The selection of an appropriate surgical modality for BPH should be assessed by fully understanding each patient's clinical conditions.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Hanyang University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: Thanks to advancements in surgical techniques and instruments, many surgical modalities have been developed to replace transurethral resection of the prostate (TURP). However, TURP remains the gold standard for the surgical treatment of benign prostatic hyperplasia (BPH). We conducted a meta-analysis on the efficacy and safety of minimally invasive surgical therapies for BPH compared with TURP.

Methods: This meta-analysis used a Medline search assessing the period from 1997 to 2011. A total of 784 randomized controlled trials were identified in an electronic search. Among the 784 articles, 36 randomized controlled trials that provided the highest level of evidence (level 1b) were included in the meta-analysis. We also conducted a quality analysis of selected articles.

Results: Only 2 articles (5.56%) were assessed as having a low risk of bias by use of the Cochrane collaboration risk of bias tool. On the other hand, by use of the Jadad scale, there were 26 high-quality articles (72.22%). Furthermore, 28 articles (77.78%) were assessed as high-quality articles by use of the van Tulder scale. Holmium laser enucleation of the prostate (HoLEP) showed the highest reduction of the International Prostate Symptom Score compared with TURP (P<0.0001). Bipolar TURP, bipolar transurethral vaporization of the prostate, HoLEP, and open prostatectomy showed superior outcome in postvoid residual urine volume and maximum flow rate. The intraoperative complications of the minimally invasive surgeries had no statistically significant inferior outcomes compared with TURP. Also, there were no statistically significant differences in any of the modalities compared with TURP.

Conclusions: The selection of an appropriate surgical modality for BPH should be assessed by fully understanding each patient's clinical conditions.

No MeSH data available.


Related in: MedlinePlus

Forest plot of late complications. OR, odds ratio; CI, confidence interval; TURP, transurethral resection of the prostate; TUVP, transurethral vaporization of the prostate; HoLEP, holmium laser enucleation of the prostate; KTP, potassium-titanyl-phosphate.
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Figure 7: Forest plot of late complications. OR, odds ratio; CI, confidence interval; TURP, transurethral resection of the prostate; TUVP, transurethral vaporization of the prostate; HoLEP, holmium laser enucleation of the prostate; KTP, potassium-titanyl-phosphate.

Mentions: KTP and HoLEP showed statistically significantly inferior outcomes compared with TURP (P<0.0001, P=0.0342, respectively). Acute urinary retention, secondary apical resection, and febrile urinary tract infection occurred most commonly with KTP. TURP showed the highest occurrence rate of clot retention and hematuria episodes (Table 4).


Transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement: a quality and meta-analysis.

Lee SW, Choi JB, Lee KS, Kim TH, Son H, Jung TY, Oh SJ, Jeong HJ, Bae JH, Lee YS, Kim JC - Int Neurourol J (2013)

Forest plot of late complications. OR, odds ratio; CI, confidence interval; TURP, transurethral resection of the prostate; TUVP, transurethral vaporization of the prostate; HoLEP, holmium laser enucleation of the prostate; KTP, potassium-titanyl-phosphate.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3713243&req=5

Figure 7: Forest plot of late complications. OR, odds ratio; CI, confidence interval; TURP, transurethral resection of the prostate; TUVP, transurethral vaporization of the prostate; HoLEP, holmium laser enucleation of the prostate; KTP, potassium-titanyl-phosphate.
Mentions: KTP and HoLEP showed statistically significantly inferior outcomes compared with TURP (P<0.0001, P=0.0342, respectively). Acute urinary retention, secondary apical resection, and febrile urinary tract infection occurred most commonly with KTP. TURP showed the highest occurrence rate of clot retention and hematuria episodes (Table 4).

Bottom Line: The intraoperative complications of the minimally invasive surgeries had no statistically significant inferior outcomes compared with TURP.Also, there were no statistically significant differences in any of the modalities compared with TURP.The selection of an appropriate surgical modality for BPH should be assessed by fully understanding each patient's clinical conditions.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Hanyang University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: Thanks to advancements in surgical techniques and instruments, many surgical modalities have been developed to replace transurethral resection of the prostate (TURP). However, TURP remains the gold standard for the surgical treatment of benign prostatic hyperplasia (BPH). We conducted a meta-analysis on the efficacy and safety of minimally invasive surgical therapies for BPH compared with TURP.

Methods: This meta-analysis used a Medline search assessing the period from 1997 to 2011. A total of 784 randomized controlled trials were identified in an electronic search. Among the 784 articles, 36 randomized controlled trials that provided the highest level of evidence (level 1b) were included in the meta-analysis. We also conducted a quality analysis of selected articles.

Results: Only 2 articles (5.56%) were assessed as having a low risk of bias by use of the Cochrane collaboration risk of bias tool. On the other hand, by use of the Jadad scale, there were 26 high-quality articles (72.22%). Furthermore, 28 articles (77.78%) were assessed as high-quality articles by use of the van Tulder scale. Holmium laser enucleation of the prostate (HoLEP) showed the highest reduction of the International Prostate Symptom Score compared with TURP (P<0.0001). Bipolar TURP, bipolar transurethral vaporization of the prostate, HoLEP, and open prostatectomy showed superior outcome in postvoid residual urine volume and maximum flow rate. The intraoperative complications of the minimally invasive surgeries had no statistically significant inferior outcomes compared with TURP. Also, there were no statistically significant differences in any of the modalities compared with TURP.

Conclusions: The selection of an appropriate surgical modality for BPH should be assessed by fully understanding each patient's clinical conditions.

No MeSH data available.


Related in: MedlinePlus