Myong Kim1, Chang Wook Jeong1, Seung-June Oh2. 1. Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea; Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital (CWJ, SJO), Seoul, Republic of Korea. 2. Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea; Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital (CWJ, SJO), Seoul, Republic of Korea. Electronic address: sjo@snu.ac.kr.
Abstract
PURPOSE: We investigated the effect of preoperative urodynamic detrusor underactivity on the transurethral surgery outcomes of benign prostatic hyperplasia. MATERIALS AND METHODS: We systematically searched the online PubMed®, Embase® and Cochrane Library databases for articles published between January 1989 and June 2017. RESULTS: A total of 10 articles met the eligibility criteria for this systematic review. The eligible studies included a total of 1,113 patients with a median of 73 per study (range 40 to 382). Five of the 10 studies involved conventional transurethral prostatectomy and 5 described laser surgery. In patients with detrusor underactivity the pooled mean difference was significant for the poorer I-PSS (International Prostate Symptom Score) (pooled mean difference -3.73, 95% CI -5.65--1.80 for 9 studies and 936 participants) and maximal flow rate improvement (pooled mean difference -3.92, 95% CI -4.85--3.00 for 8 studies and 951 participants) but not for quality of life score (pooled mean difference -0.15, 95% CI -0.56-0.25 for 7 studies and 858 participants) or post-void residual volume (pooled mean difference -5.57, 95% CI -20.65-9.50 for 9 studies and 971 participants). Some comparisons showed interstudy heterogeneity despite strict selection criteria for the included studies. However, there was no clear evidence of publication bias in this meta-analysis. CONCLUSIONS: Our meta-analysis results showed that preoperative detrusor underactivity correlated with poorer I-PSS and maximal flow rate improvement. Preoperative urodynamic detrusor underactivity is a valuable finding for excluding patients who are inappropriate candidates for transurethral surgery.
PURPOSE: We investigated the effect of preoperative urodynamic detrusor underactivity on the transurethral surgery outcomes of benign prostatic hyperplasia. MATERIALS AND METHODS: We systematically searched the online PubMed®, Embase® and Cochrane Library databases for articles published between January 1989 and June 2017. RESULTS: A total of 10 articles met the eligibility criteria for this systematic review. The eligible studies included a total of 1,113 patients with a median of 73 per study (range 40 to 382). Five of the 10 studies involved conventional transurethral prostatectomy and 5 described laser surgery. In patients with detrusor underactivity the pooled mean difference was significant for the poorer I-PSS (International Prostate Symptom Score) (pooled mean difference -3.73, 95% CI -5.65--1.80 for 9 studies and 936 participants) and maximal flow rate improvement (pooled mean difference -3.92, 95% CI -4.85--3.00 for 8 studies and 951 participants) but not for quality of life score (pooled mean difference -0.15, 95% CI -0.56-0.25 for 7 studies and 858 participants) or post-void residual volume (pooled mean difference -5.57, 95% CI -20.65-9.50 for 9 studies and 971 participants). Some comparisons showed interstudy heterogeneity despite strict selection criteria for the included studies. However, there was no clear evidence of publication bias in this meta-analysis. CONCLUSIONS: Our meta-analysis results showed that preoperative detrusor underactivity correlated with poorer I-PSS and maximal flow rate improvement. Preoperative urodynamic detrusor underactivity is a valuable finding for excluding patients who are inappropriate candidates for transurethral surgery.
Authors: Kang Jun Cho; Jun Sung Koh; Jin Bong Choi; Sang Hi Park; Weon Sun Lee; Joon Chul Kim Journal: Int Neurourol J Date: 2021-05-06 Impact factor: 2.835