Marcelo Langer Wroclawski1,2,3, Daniele Castellani4, Flavio L Heldwein5, Saulo Borborema Teles6, Jonathan Doyun Cha6, Hongda Zhao7, Thomas Herrmann8,9, Vinson Wai-Shun Chan10, Jeremy Yuen-Chun Teoh7. 1. Hospital Israelita Albert Einstein, São Paulo, Brazil. urologia.marcelo@gmail.com. 2. BP-a Beneficência Portuguesa de São Paulo, São Paulo, Brazil. urologia.marcelo@gmail.com. 3. Faculdade de Medicina Do ABC, Santo André, Brazil. urologia.marcelo@gmail.com. 4. Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Università Politecnica Delle Marche, Ancona, Italy. 5. Department of Urology, Federal University of Santa Catarina, Florianópolis, Brazil. 6. Hospital Israelita Albert Einstein, São Paulo, Brazil. 7. S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China. 8. Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland. 9. Department of Urology, Hanover Medical School (MHH), Hanover, Germany. 10. School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK.
Abstract
PURPOSE AND OBJECTIVE: To evaluate and compare the incidences of post-operative pelvic pain (PPP) in patients undergoing ablation, enucleation and conventional transurethral resection of the prostate (TURP). METHODS: A systematic review and meta-analysis was conducted according to the PRISMA guidelines. Using MEDLINE via PubMed and Cochrane CENTRAL, randomised control trials (RCTs) and observational studies reporting PPP rates post-ablation, enucleation or TURP were identified. The risk of biases (RoB) in RCTs and observation studies were assessed using the Cochrane RoB1.0 tool and the Newcastle-Ottawa Scale, respectively. RESULTS: 62 studies were included for qualitative analysis, while 51 of them reported number of patients with PPP post-intervention. Three observational studies and 13 RCTs compared the rates of PPP in patients undergoing ablation, enucleation or TURP. The most reported types of PPP are dysuria, abdominal pain and irritative symptoms. The pooled incidence of PPP at 1-month follow-up in patients undergoing ablation, enucleation and TURP were 0.15 (95% CI 0.10-0.22), 0.09 (95% CI 0.04-0.19 and 0.10 (95% CI 0.06-0.15), respectively. PPP is no longer prevalent at 3-months and onwards post-operatively. Ablation is associated with a higher risk of PPP than enucleation (RR 2.19, 95% CI 1.04-4.62) and TURP (RR 2.40, 95% CI 1.03-5.62) in observational studies but not RCTs; and there were no significant differences in the rates of PPP upon comparison of other modalities. CONCLUSION: PPP is common after transurethral benign prostatic hyperplasia surgery. Patients undergoing ablation had a higher rate of post-intervention PPP than those undergoing enucleation and TURP in observational studies.
PURPOSE AND OBJECTIVE: To evaluate and compare the incidences of post-operative pelvic pain (PPP) in patients undergoing ablation, enucleation and conventional transurethral resection of the prostate (TURP). METHODS: A systematic review and meta-analysis was conducted according to the PRISMA guidelines. Using MEDLINE via PubMed and Cochrane CENTRAL, randomised control trials (RCTs) and observational studies reporting PPP rates post-ablation, enucleation or TURP were identified. The risk of biases (RoB) in RCTs and observation studies were assessed using the Cochrane RoB1.0 tool and the Newcastle-Ottawa Scale, respectively. RESULTS: 62 studies were included for qualitative analysis, while 51 of them reported number of patients with PPP post-intervention. Three observational studies and 13 RCTs compared the rates of PPP in patients undergoing ablation, enucleation or TURP. The most reported types of PPP are dysuria, abdominal pain and irritative symptoms. The pooled incidence of PPP at 1-month follow-up in patients undergoing ablation, enucleation and TURP were 0.15 (95% CI 0.10-0.22), 0.09 (95% CI 0.04-0.19 and 0.10 (95% CI 0.06-0.15), respectively. PPP is no longer prevalent at 3-months and onwards post-operatively. Ablation is associated with a higher risk of PPP than enucleation (RR 2.19, 95% CI 1.04-4.62) and TURP (RR 2.40, 95% CI 1.03-5.62) in observational studies but not RCTs; and there were no significant differences in the rates of PPP upon comparison of other modalities. CONCLUSION: PPP is common after transurethral benign prostatic hyperplasia surgery. Patients undergoing ablation had a higher rate of post-intervention PPP than those undergoing enucleation and TURP in observational studies.
Authors: Marcelo L Wroclawski; Arie Carneiro; Rodrigo Dal Moro Amarante; Carlos E B Oliveira; Victor Shimanoe; Bianca A V Bianco; Paulo K Sakuramoto; Antonio C L Pompeo Journal: BJU Int Date: 2015-10-03 Impact factor: 5.588
Authors: Alexander Bachmann; Leander Schürch; Robin Ruszat; Stephen F Wyler; Hans-Helge Seifert; Alexander Müller; Kurt Lehmann; Tullio Sulser Journal: Eur Urol Date: 2005-07-18 Impact factor: 20.096
Authors: Abdulla Al-Ansari; Nagy Younes; Venkataramana Pai Sampige; Khalid Al-Rumaihi; Ardalan Ghafouri; Tawiz Gul; Ahmed A Shokeir Journal: Eur Urol Date: 2010-05-27 Impact factor: 20.096
Authors: Sascha A Ahyai; Peter Gilling; Steven A Kaplan; Rainer M Kuntz; Stephan Madersbacher; Francesco Montorsi; Mark J Speakman; Christian G Stief Journal: Eur Urol Date: 2010-06-11 Impact factor: 20.096