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Transurethral surgical treatment for benign prostatic hyperplasia with detrusor underactivity: a systematic review and meta-analysis
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Transurethral surgical treatment for benign prostatic hyperplasia with detrusor underactivity: a systematic review and meta-analysis
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Journal Article
Transurethral surgical treatment for benign prostatic hyperplasia with detrusor underactivity: a systematic review and meta-analysis
2024
Overview
Background
The efficacy of surgical treatment for benign prostatic hyperplasia (BPH) patients with detrusor underactivity (DU) remains controversial.
Methods
To summarize relevant evidence, three databases (PubMed, Embase, and Web of Science) were searched from database inception to May 1, 2023. Transurethral surgical treatment modalities include transurethral prostatectomy (TURP), photoselective vaporization of the prostate (PVP), and transurethral incision of the prostate (TUIP). The efficacy of the transurethral surgical treatment was assessed according to maximal flow rate on uroflowmetry (
Q
max
), International Prostate Symptom Score (IPSS), postvoid residual (PVR), quality of life (QoL), voided volume, bladder contractility index (BCI) and maximal detrusor pressure at maximal flow rate (PdetQ
max
). Pooled mean differences (MDs) were used as summary statistics for comparison. The quality of enrolled studies was evaluated by using the Newcastle–Ottawa Scale. Sensitivity analysis and funnel plots were applied to assess possible biases.
Results
In this study, 10 studies with a total of 1142 patients enrolled. In BPH patients with DU, within half a year, significant improvements in
Q
max
(pooled MD, 4.79; 95% CI, 2.43–7.16;
P
< 0.05), IPSS(pooled MD, − 14.29; 95%CI, − 16.67–11.90;
P
< 0.05), QoL (pooled MD, − 1.57; 95% CI, − 2.37–0.78;
P
< 0.05), voided volume (pooled MD, 62.19; 95% CI, 17.91–106.48;
P
< 0.05), BCI (pooled MD, 23.59; 95% CI, 8.15–39.04;
P
< 0.05), and PdetQ
max
(pooled MD, 28.62; 95% CI, 6.72–50.52;
P
< 0.05) were observed after surgery. In addition, after more than 1 year, significant improvements were observed in
Q
max
(pooled MD, 6.75; 95%CI, 4.35–9.15;
P
< 0.05), IPSS(pooled MD, − 13.76; 95%CI, − 15.17–12.35;
P
< 0.05), PVR (pooled MD, − 179.78; 95%CI, − 185.12–174.44;
P
< 0.05), QoL (pooled MD, − 2.61; 95%CI, − 3.12–2.09;
P
< 0.05), and PdetQ
max
(pooled MD, 27.94; 95%CI, 11.70–44.19;
P
< 0.05). Compared with DU patients who did not receive surgery, DU patients who received surgery showed better improvement in PVR (pooled MD, 137.00; 95%CI, 6.90–267.10;
P
< 0.05) and PdetQ
max
(pooled MD, − 8.00; 95%CI, − 14.68–1.32;
P
< 0.05).
Conclusions
Our meta-analysis results showed that transurethral surgery can improve the symptoms of BPH patients with DU. Surgery also showed advantages over pharmacological treatment for BPH patients with DU.
Systematic review registration
PROSPERO CRD42023415188.
Publisher
BioMed Central,Springer Nature B.V,BMC
