Transurethral Procedures for Lower Urinary Tract Symptoms Resulting From Benign Prostatic Enlargement: A Quality and Meta-Analysis
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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.
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.
참고문헌 (17)
- Lepor H, "Pathophysiology, epidemiology, and natural history of benign prostatic hyperplasia", Rev Urol, 6(Suppl 9), pp.S3~S10 (2004)
- Hoke GP, "Epidemiology of benign prostatic hyperplasia and comorbidities in racial and ethnic minority populations", Am J Med, 121(8 Suppl 2), pp.S3~S10 (2008)
- Speakman MJ, "Who should be treated and how? Evidence-based medicine in symptomatic BPH", Eur Urol, 36(Suppl 3), pp.40~51 (1999)
- Souverein PC, "Drug treatment of benign prostatic hyperplasia and hospital admission for BPH-related surgery", Eur Urol, 43, pp.528~534 (2003)
- Rassweiler J, "Complications of transurethral resection of the prostate (TURP): incidence, management, and prevention", Eur Urol, 50, pp.969~979 (2006)
- Ahyai SA, "Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement", Eur Urol, 58, pp.384~397 (2010)
- 정재훈, "Assessing the Quality of Randomized Controlled Trials Published in the Journal of Korean Medical Science from 1986 to 2011", Journal of Korean Medical Science, 27(9), pp.973~980 (2012), 대한의학회
- Higgins JP, "Measuring inconsistency in meta-analyses", BMJ, 327, pp.557~560 (2003)
- Auffenberg GB, "Established medical therapy for benign prostatic hyperplasia", Urol Clin North Am, 36, pp.443~459 (2009)
- Madersbacher S, "EAU 2004 guidelines on assessment, therapy and follow-up of men with lower urinary tract symptoms suggestive of benign prostatic obstruction (BPH guidelines)", Eur Urol, 46, pp.547~554 (2004)
- McVary KT, "Update on AUA guideline on the management of benign prostatic hyperplasia", J Urol, 185, pp.1793~1803 (2011)
- Marberger M, "Optimising the medical management of benign prostatic hyperplasia", Eur Urol, 45, pp.411~419 (2004)
- Chapple CR, "Alpha adrenoceptor antagonists in the year 2000: is there anything new?", Curr Opin Urol, 11, pp.9~16 (2001)
- Taylor J, "The pattern and progression of lower urinary tract symptoms after transurethral prostatectomy compared with those seen in the general population", Eur Urol, 51, pp.1023~1029 (2007)
- Mebust WK, "Transurethral prostatectomy: immediate and postoperative complications. A cooperative study of 13 participating institutions evaluating 3,885 patients", J Urol, 141, pp.243~247 (1989)
- Naspro R, "Holmium laser enucleation of the prostate versus open prostatectomy for prostates >70 g: 24-month follow-up", Eur Urol, 50, pp.563~568 (2006)
- Kuntz RM, "Transurethral holmium laser enucleation versus transvesical open enucleation for prostate adenoma greater than 100 gm.:: a randomized prospective trial of 120 patients", J Urol, 168(4 Pt 1), pp.1465~1469 (2002)