Urethral stricture following endoscopic prostate surgery: a systematic review and meta-analysis of prospective, randomized trials

Pirola, Giacomo Maria; Castellani, Daniele; Lim, Ee Jean; Wroclawski, Marcelo Langer; Nguyen, Dong Le Quy; Gubbiotti, Marilena; Rubilotta, Emanuele; Chan, Vinson Wai-Shun; Corrales, Mariela; Rojo, Esther García; Herrmann, Thomas; Teoh, Jeremy Yuen‐Chun; Gauhar, Vineet

doi:10.1007/s00345-022-03946-z

Cited by 18 publications

(8 citation statements)

References 85 publications

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“…Concerning delayed complications, rates of urethral (1.5%) and bladder neck stenosis (0.5%) were within the literature incidence (1.7% and 0.66%, respectively) [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 51%

Incidence of complications and urinary incontinence following endoscopic enucleation of the prostate in men with a prostate volume of 80 ml and above: results from a multicenter, real-world experience of 2512 patients

Gauhar,

Castellani,

Herrmann

et al. 2024

World J Urol

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Purpose To evaluate complications and urinary incontinence (UI) after endoscopic enucleation of the prostate (EEP) stratified by prostate volume (PV). Methods We retrospectively reviewed patients with benign prostatic hyperplasia who underwent EEP with different energy sources in 14 centers (January 2019–January 2023). Inclusion criteria: prostate volume ≥ 80 ml. Exclusion criteria: prostate cancer, previous prostate/urethral surgery, pelvic radiotherapy. Primary outcome: complication rate. Secondary outcomes: incidence of and factors affecting postoperative UI. Patients were divided into 3 groups. Group 1: PV = 80–100 ml; Group 2 PV = 101–200 ml; Group 3 PV > 200 ml. Multivariable logistic regression analysis was performed to evaluate independent predictors of overall incontinence. Results There were 486 patients in Group 1, 1830 in Group 2, and 196 in Group 3. The most commonly used energy was high-power Holmium laser followed by Thulium fiber laser in all groups. Enucleation, morcellation, and total surgical time were significantly longer in Group 2. There was no significant difference in overall 30-day complications and readmission rates. Incontinence incidence was similar (12.1% in Group 1 vs. 13.2% in Group 2 vs. 11.7% in Group 3, p = 0.72). The rate of stress and mixed incontinence was higher in Group 1. Multivariable regression analysis showed that age (OR 1.019 95% CI 1.003–1.035) was the only factor significantly associated with higher odds of incontinence. Conclusions PV has no influence on complication and UI rates following EEP. Age is risk factor of postoperative UI.

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“…Concerning delayed complications, rates of urethral (1.5%) and bladder neck stenosis (0.5%) were within the literature incidence (1.7% and 0.66%, respectively) [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 51%

Incidence of complications and urinary incontinence following endoscopic enucleation of the prostate in men with a prostate volume of 80 ml and above: results from a multicenter, real-world experience of 2512 patients

Gauhar,

Castellani,

Herrmann

et al. 2024

World J Urol

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“…Although TURP is more satisfactory than other minimally invasive surgical methods, such as laser vaporization and prostate kernel dissection, and postoperative patient subjective functional indicators such as IPSS, QoL, and IIEF-S, TURP is associated with a significant increase in the incidence of postoperative complications, reoperation rate, and perioperative mortality in patients with a large volume of BPH (>80 mL). Most of them are caused by massive postoperative bleeding (29). More importantly, postoperative complications are higher in patients with long-term use of anticoagulants and PV greater than 80 mL.…”

Section: Discussionmentioning

confidence: 99%

Comparison of effectiveness and postoperative complications of different surgical methods in the treatment of benign prostatic hyperplasia: a systematic review and meta-analysis based on randomized controlled trials

Fu¹,

Wen²,

Yin³

et al. 2022

Transl Androl Urol

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Background: More and more new surgical procedures for the treatment of benign prostate hyperplasia (BPH) are proposed creatively. However, the existing clinical evidence shows that the effectiveness and safety of various procedures exist inconsistent. Methods:The randomized controlled trials comparing the international prostate score, length of hospital stay, maximum urinary flow rate, operation time, and complication rates of prostatic artery embolization (PAE), Greenlight-XPS Laser prostate vaporization procedure (GLL PVP), diode laser enucleation of prostate (DILEP) and plasmakinetic resection of the prostate (PKRP), transurethral resection of the prostate (TURP) in patients with BPH were screened out in databases. The primary outcome was pooled using a restricted maximum likelihood-based random-effect model and inverse variance-based fixed-effect model.Cochrane Q statistics and I2 statistics were computed to quantify between-study heterogeneity. The risk of bias of each included study was assessed using the revised Cochrane risk of bias tool.Results: This meta-analysis ultimately included 14 original research papers, with 1,940 participants enrolled. Eight studies were considered to be at moderate risk of bias, while the others were at mild risk of bias. Although the improvement in functional outcome of the DILEP procedure was equivalent to that of the PKRP procedure, the DILEP procedure group had fewer hospital stays than the PKRP group (P=0.01).In addition, even though the performance of the GLL PVP procedure in the improvement of functional outcome was inferior to the counterpart of TURP (P=0.64), it had a much fewer hospital stays (P=0.01).

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“…Total rates of complications according to the Clavien-Dindo classification were 41.1% (23.5% [grade I], 9.8% [grade II], 5.9% [grade IIIa], and 2% [grade IIIb]) (Table 3). According to a recent review, complications in the transurethral enucleation surgeries showed the respective rates of stress and urge incontinence to be 0.7-28.6% and 0.6-48.1% and those of urethral stricture and bladder neck sclerosis to be 0.6-8.7% and 0.5-3.6% [29][30][31]. Although the rates of urethral stricture and bladder neck sclerosis might be relatively high (5.9% and 2%), we thought that the incidences of these complications were comparable with these previous studies [29][30][31].…”

Section: Plos Onementioning

confidence: 99%

Influence of transurethral enucleation with bipolar of the prostate on erectile function: Prospective analysis of 51 patients at 12-month follow-up

2022

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Background Transurethral enucleation with bipolar (TUEB) is a safe and effective surgery for benign prostatic obstruction (BPO). However, few data exist concerning the influence of TUEB on erectile function (EF) in patients with BPO. Objective To evaluate the influence of TUEB on EF in patients with BPO at 3- and 12-month follow-up. Material and methods We prospectively enrolled 51 patients who underwent TUEB from June 2016 to April 2020. We evaluated maximum urinary flow rate (Qmax), postvoid residual urine (PVR), International Prostate Symptom Score (IPSS), quality of life (QoL), and International Index of Erectile Function-5 (IIEF-5) preoperatively and at 3- and 12-month follow-up. We classified the patients according to their preoperative IIEF-5 score into group 1 (IIEF-5 ≥10; n = 24) and group 2 (IIEF-5 <10; n = 27), and for further evaluation of EF, into subgroups a: severe (IIEF-5 5–7), b: moderate (8–11), c: mild to moderate (12–16), d: mild (17–21), and e: no erectile dysfunction (22–25). Data are displayed as median or median (interquartile range). Results The study comprised 51 patients with a median age of 75 (70.5–79.5) years. Median prostate and transition zone volumes were 69.5 (46.5–78.8) mL and 30.5 (19–43) mL, respectively. Urinary function improved significantly when comparing respective preoperative, 3-month, and 12-month follow-up values: Qmax (7.6, 12.9, 15.2 mL/s), PVR (50, 0, 0 mL), IPSS (20.5, 9, 6), and QoL (5, 2, 2), respectively. There was no significant change in IIEF-5 score across the three time points: 9, 7, 8. The IIEF-5 score slightly but significantly increased between the preoperative and 12-month follow-up values in group 2 (5, 5, 6) and subgroup a (5, 5, 5). Conclusion TUEB was effective and safe surgery for patients with BPO and showed no significant influence on EF at 12-month follow-up after TUEB in patients with BPO.

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Urethral stricture following endoscopic prostate surgery: a systematic review and meta-analysis of prospective, randomized trials

Cited by 18 publications

References 85 publications

Incidence of complications and urinary incontinence following endoscopic enucleation of the prostate in men with a prostate volume of 80 ml and above: results from a multicenter, real-world experience of 2512 patients

Incidence of complications and urinary incontinence following endoscopic enucleation of the prostate in men with a prostate volume of 80 ml and above: results from a multicenter, real-world experience of 2512 patients

Comparison of effectiveness and postoperative complications of different surgical methods in the treatment of benign prostatic hyperplasia: a systematic review and meta-analysis based on randomized controlled trials

Influence of transurethral enucleation with bipolar of the prostate on erectile function: Prospective analysis of 51 patients at 12-month follow-up

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