📃 Paper Title: Meta-analysis of Functional Outcomes and Complications Following Transurethral Procedures for Lower Urinary Tract Symptoms Resulting from Benign Prostatic Enlargement
🧍 Author: Ahyai
🕒 Year: 2010
📚 Journal: European Urology
🌎 Country: Germany
ㅤContext to the study:
Can you tell me about a study examining minimally invasive surgical therapies for BPH?
ㅤ✅ Take-home message of study:
In patients with benign prostatic hyperplasia (BPH), minimally invasive surgical therapies (MIST) have comparable efficacy and morbidity to transurethral resection of the prostate (TURP).
Varied safety profile and lack of long-term outcome measures for MIST mean that careful technique selection individualised to the patient is advised.
ㅤ Meta-analysis
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Study participants:
Participants
Number included: 2245 patients from 27 publications involving 23 randomised controlled trials (RCT). 2085 excluding those randomised to simple open prostatectomy
Inclusion Criteria
RCT comparing MIST (Bipolar TURP, Bipolar transurethral vaporisation of the prostate (TUVP), Holmium laser enucleation of the prostate (HoLEP) and potassium-titanyl-phosphate (KTP) laser vaporisation of the prostate) with either TURP or simple open prostatectomy
Published between 1997 and 2009
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Key study outcomes:
HoLEP produced a superior International Prostate Symptom Score (IPSS) reduction and a superior reduction in Qmax compared to TURP, making it the only endoscopic procedure with proven superior efficacy to TURP. Complications are less frequent after HoLEP than after TURP and long term (5 year) follow up demonstrates sustained efficacy.
Bipolar TURP has comparative functional results to monopolar TURP, but has the advantage of less frequent complications and overall morbidity.
Bipolar TUVP has comparative initial efficacy to TURP and fewer intra- and peri-operative complications; however, it is associated with higher risk of post-operative acute urinary retention, and inferior clinical outcomes at midterm follow up.
KTP laser had comparative functional results to TURP at short term follow up for small to mid-size prostates, and no statistically different complication rate compared with TURP.
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Study Limitations:
Majority of studies included had maximum follow up of one year or less, therefore limited evaluation of long-term efficacy
Limited RCT data
No use of non-inferiority statistics
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