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In men with benign prostatic obstruction, some newer transurethral surgeries reduce symptoms better or speed recovery time

Cornu JN, Ahyai S, Bachmann A, et al. A Systematic Review and Meta-analysis of Functional Outcomes and Complications Following Transurethral Procedures for Lower Urinary Tract Symptoms Resulting from Benign Prostatic Obstruction: An Update. Eur Urol. 2014 Jun 24. pii: S0302-2838(14)00538-7.

Review question

In men with lower urinary tract symptoms due to benign prostatic obstruction (enlargement of the prostate gland), how effective and safe are the different surgical procedures?

Background

Benign prostatic obstruction is due to enlargement of the prostate gland. It can cause urinary symptoms and potentially block the flow of urine. There are medications available to treat the condition. If these are not effective or if symptoms are severe, men may choose to have surgery to reduce the size of the prostate gland. Over the past 20 years, several new surgical procedures have been developed and compared with the previous standard: monopolar transurethral resection of the prostate (MTURP).

How the review was done

The researchers did a systematic review, searching for randomized controlled trials that were published between 1992 and September 2013. They found 69 trials with 8517 men (average age 59 to 76 years). The trials compared MTURP with the following transurethral surgeries: bipolar transurethral resection of the prostate (BTURP), plasmakinetic (PK) bipolar resection, transurethral resection in saline (TURis), holmium laser enucleation of the prostate (HoLEP), and photovaporization of the prostate (PVP).

What the researchers found

Most studies were of low quality; only 15 studies scored 3 or more out of 5 on the quality scale.

The International Prostate Symptom Score is a measure of the effect of treatment. It collects information on the following symptoms: sensation of incomplete emptying, urinary frequency, intermittent stream, urge incontinence, weak urine stream, straining, and frequency of night-time urination.

As shown in the Table, compared with MTURP, newer surgeries resulted in similar or better International Prostate Symptom Scores after 12 months.

Some of the newer surgeries reduced complications or recovery time, as shown by reduced length of hospital stay.

Conclusions

In men with benign prostatic obstruction, newer transurethral surgeries are as effective as, or better than, monopolar transurethral resection of the prostate. Some newer surgeries reduce postoperative complications.

Newer transurethral surgeries vs monopolar transurethral resection of the prostate (MTURP) in men with benign prostatic obstruction

Outcomes

Surgery comparisons

Number of trials (people)

Effect of newer surgery vs MTURP

International Prostate Symptom Score at 12 months

Any BTURP vs MTURP

10 trials (1302 people)

No difference in effect

 

PK vs MTURP

7 trials (784 people)

No difference in effect

 

TURis vs MTURP

2 trials (357 people)

No difference in effect

 

HoLEP vs MTURP

5 trials (507 people)

HoLEP improved symptom scores more than MTURP

 

PVP vs MTURP

4 trials (360 people)

No difference in effect

Length of hospital stay

Any BTURP vs MTURP

9 trials (1276 people)

BTURP reduced the length of hospital stay by about 1 day

 

PK vs MTURP

5 trials (665 people)

PK reduced the length of hospital stay by about 1 day

 

HoLEP vs MTURP

4 trials (310 people)

No difference between groups

 

PVP vs MTURP

3 trials (438 people)

PVP reduced the length of hospital stay by about 2 days

BTURP = bipolar transurethral resection of the prostate; PK = plasmakinetic bipolar resection; TURis = transurethral resection in saline; HoLEP = holmium laser enucleation of the prostate; PVP = photovaporization of the prostate.




Glossary

Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

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