Int Neurourol J.
2013 Jun;17(2):59-66.
Transurethral Procedures for Lower Urinary Tract Symptoms Resulting From Benign Prostatic Enlargement: A Quality and Meta-Analysis
- Affiliations
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- 1Department of Urology, Hanyang University College of Medicine, Seoul, Korea.
- 2Department of Urology, Ajou University School of Medicine, Suwon, Korea.
- 3Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicne, Seoul, Korea.
- 4Department of Urology, Chung-Ang University College of Medicine, Seoul, Korea.
- 5Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea.
- 6Department of Urology, Veterans Health Service Medical Center, Seoul, Korea.
- 7Department of Urology, Seoul National University Hospital, Seoul, Korea.
- 8Department of Urology, Wonkwang University School of Medicine & Hospital, Iksan, Korea.
- 9Department of Urology, Korea University College of Medicine, Seoul, Korea.
- 10Department of Urology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
- 11Department of Urology, The Catholic University College of Medicine, Seoul, Korea. kjc@catholic.ac.kr
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.
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