The role of transurethral resection of prostate (TURP) in patients with underactive bladder: 12 months follow‐up in different grades of detrusor contractility

Lebani, Bruno Rodrigues; Barcelos, André da Silva; Gouveia, Denise Sbrissia E Silva; Girotti, M; Remaille, Eduardo Pinto; Skaff, Milton; Almeida, Fernando G.

doi:10.1002/pros.24526

Cited by 7 publications

(6 citation statements)

References 23 publications

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“…1). Ultimately, 10 studies were included in the meta-analysis with 1142 patients enrolled (Table 1) [10][11][12][13][14][15][16][17][18][19].…”

Section: Search Resultsmentioning

confidence: 99%

Transurethral surgical treatment for benign prostatic hyperplasia with detrusor underactivity: a systematic review and meta-analysis

Zou,

Liu,

Zhang

et al. 2024

Syst Rev

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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 (Qmax), 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 (PdetQmax). 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 Qmax (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 PdetQmax (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 Qmax (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 PdetQmax (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 PdetQmax (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.

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“…1). Ultimately, 10 studies were included in the meta-analysis with 1142 patients enrolled (Table 1) [10][11][12][13][14][15][16][17][18][19].…”

Section: Search Resultsmentioning

confidence: 99%

Transurethral surgical treatment for benign prostatic hyperplasia with detrusor underactivity: a systematic review and meta-analysis

Zou,

Liu,

Zhang

et al. 2024

Syst Rev

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“…Finally, 17 studies were accepted and included for meta-analysis. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Figure 1 shows the PRISMA flow diagram.…”

Section: Resultsmentioning

confidence: 99%

“…Table 1 shows characteristics of the included studies. There were 5 prospective nonrandomized studies 14,17,18,22,25 and 12 retrospective studies, [9][10][11][12][13]15,16,[19][20][21]23,24 including 1701 DUA and 1993 NC patients. Regarding surgical procedures and in accordance with the ICS (International Continence Society) report on the terminology for male lower urinary tract surgery, 26 there were eight TURP studies, four GreenLight PVP (photoselective vaporization of the prostate; also known as GreenLight laser vaporization of the prostate) studies, two HoLEP studies, one GreenLight PVP/HoLEP study, one Holmium laser incision of the prostate study, and one study did not report the type of surgery.…”

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

Functional and safety outcomes after benign prostatic enlargement surgeries in men with detrusor underactivity compared with normal detrusor contractility: Systematic review and meta‐analysis

Wroclawski,

Takemura,

Santos

et al. 2023

Neurourology and Urodynamics

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IntroductionMen with detrusor underactivity (DUA) and concomitant bladder outlet obstruction (BOO) due to benign prostatic enlargement (BPE) may present poorer functional outcomes after surgical desobstruction. This study aimed to evaluate the safety and efficacy of BPE surgery in men with DUA compared with those with normal detrusor contractility (NC).Materials and MethodsThis review was performed according to the 2020 PRISMA framework. A comprehensive literature search was performed until May 7, 2023, using MEDLINE, EMBASE, and Cochrane Database. No date limits were imposed. Only comparative studies were accepted. The primary endpoint was to assess if there was any difference in short‐ and long‐term functional outcomes after BPE surgery in men with DUA and NC. The secondary endpoint was to evaluate the differences in perioperative outcomes and postoperative complications between the two groups. Meta‐analysis was performed using Review Manager (RevMan) software.ResultsThere were 5 prospective nonrandomized studies and 12 retrospective studies, including 1701 DUA and 1993 NC patients. Regarding surgical procedures, there were eight TURP (transurethral resection of the prostate) studies, four GreenLight PVP (photoselective vaporization of the prostate) studies, two HoLEP (Holmium laser enucleation of the prostate) studies, one GreenLight PVP/HoLEP study, one Holmium laser incision of the prostate study, and one study did not report the type of surgery. We did not find a statistically significant difference between the two groups in terms of perioperative outcomes, including postoperative catheterization time, hospitalization time, urinary retention, need to recatheterization, transfusion rate, or urinary tract infections. Also, we found no significant differences in long‐term complications, such as bladder neck stenosis or urethral stenosis. Posttreatment bladder recatheterization and retreatment rate for BPE regrowth could not be evaluated properly, because only one study reported these findings. When we analyzed functional outcomes at 3 months, those with NC had lower International Prostatic Symptom Score (IPSS), lower quality‐of‐life (QoL) score, better maximum flow rate (Qmax), and lower post‐voiding residual (PVR) of urine. These results were maintained at 6 months postoperatively, with exception of PVR that showed no difference. However, at 12 and more than 12 months the functional outcomes became similar regarding IPSS and QoL. There were few data about Qmax and PVR at longer follow‐up.ConclusionIn this meta‐analysis, data suggest that BOO surgical treatment in patients with concomitant BPE and DUA appears to be safe. Despite patients with DUA may present worse functional outcomes in the short postoperative term compared with the NC population, IPSS and QoL scores become comparable again after a longer follow‐up period after surgery.

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“…On the other hand, improvements in the total IPSS, IPSS-QoL, Qmax, and PVR were similar between patients with and without preoperative DO [29,30]. Although several studies on the subject have been published, the exact role of DUA and DO before surgical intervention is still to be determined [27,28,[31][32][33][34][35][36][37].…”

Section: Discussionmentioning

confidence: 99%

Post-Voided Residual Ratio Does Not Predict Trifecta Outcome after Transurethral Resection of Prostate

Lombardo,

Ghezzo,

Sarcinelli

et al. 2024

Life

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The purpose of this study was to assess the importance of the post-void residual (PVR) ratio (PVR ratio) in achieving a favorable trifecta outcome for patients suffering from lower urinary tract symptoms and benign prostatic enlargement (LUTS-BPE) who undergo transurethral resection of the prostate (TURP). Starting from 2015, a series of patients with LUTS-BPE who underwent TURP were included in a forward-looking study. These patients were assessed using the international prostate symptom score (IPSS) screening tool, uroflowmetry, and a transrectal ultrasound to measure prostate volume (TRUS). Both the PVR urine volume and the PVR ratio (PVR-R), which is the PVR as a percentage of total bladder volume (voided volume + PVR), were measured. The assessment of outcomes was based on the trifecta favorable outcome, defined as meeting all of the following criteria: (1) absence of perioperative complications, (2) a postoperative IPSS of less than eight, and (3) a postoperative maximum urinary flow rate (Qmax) greater than 15 mL/s. A total of 143 patients were included, with a median age of 70 years (interquartile range 65–73). Of these, 58% (83/143) achieved a positive trifecta outcome. Upon conducting a multivariate analysis, both IPSS and Qmax were identified as predictors of a positive trifecta outcome, whereas the PVR-R did not prove to be an independent predictor. In summary, it was found that preoperative IPSS and Qmax are indicative of a trifecta outcome following TURP, whereas PVR-R is not.

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The role of transurethral resection of prostate (TURP) in patients with underactive bladder: 12 months follow‐up in different grades of detrusor contractility

Cited by 7 publications

References 23 publications

Transurethral surgical treatment for benign prostatic hyperplasia with detrusor underactivity: a systematic review and meta-analysis

Transurethral surgical treatment for benign prostatic hyperplasia with detrusor underactivity: a systematic review and meta-analysis

Functional and safety outcomes after benign prostatic enlargement surgeries in men with detrusor underactivity compared with normal detrusor contractility: Systematic review and meta‐analysis

Post-Voided Residual Ratio Does Not Predict Trifecta Outcome after Transurethral Resection of Prostate

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