Daniele Castellani1, Marcelo Langer Wroclawski2,3, Giacomo Maria Pirola4, Vineet Gauhar5, Emanuele Rubilotta6, Vinson Wai-Shun Chan7, Bryan Kwun-Chung Cheng8, Marilena Gubbiotti4, Andrea Benedetto Galosi1, Thomas R W Herrmann9, Jeremy Yuen-Chun Teoh10. 1. Department of Urology, University Hospital "Ospedali Riuniti" and Polytechnic University of Marche Region, via Conca 71, 60126, Ancona, Italy. 2. Hospital Israelita Albert Einstein, BP-A Beneficência Portuguesa de São Paulo, São Paulo, Brazil. 3. Faculdade de Medicina do ABC, Santo André, Brazil. 4. Department of Urology, San Donato Hospital, Arezzo, Italy. 5. Ng Teng Fong General Hospital (NUHS), Singapore, Singapore. 6. Department of Urology, A.O.U.I. Verona University, Verona, Italy. 7. School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK. 8. Department of Surgery, United Christian Hospital, Hong Kong, China. 9. Department of Urology, Spital Thurgau AG (STGAG), Frauenfeld, Switzerland. 10. S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China. jeremyteoh@surgery.cuhk.edu.hk.
Abstract
PURPOSE: Bladder neck stenosis (BNS) is a long-term complication of surgical procedures for benign prostatic hyperplasia (BPH). We performed a systematic literature review and a meta-analysis of the incidence of BNS after transurethral procedures for BPH. METHODS: We performed a systemic literature review using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. We accepted only randomized trials comparing transurethral resection of the prostate (TURP) vs. other transurethral surgery for BPH that were grouped in Ablation vs. Enucleation modalities. The incidences of BNS were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and expressed as Risk Ratios, 95% Confidence Intervals, and p values. Study heterogeneity was assessed utilizing the I2 value. RESULTS: 72 studies were identified for meta-analysis, 46 comparing TURP vs. Ablation and 26 TURP vs. Enucleation. The pooled incidence of BNS was 1.3% after TURP, 0.66% after enucleation and 1.2% after Ablation. The incidence of BNS was higher after TURP than after Enucleation but the difference was not statistically significant (RR 1.75 95% CI 0.81-3.79, p = 0.16). There was no significant heterogeneity among the studies (I2 0%, Chi2 4.11, p = 0.90). The incidence of BNS was higher after TURP than after Ablation, but the difference was not statistically significant (RR 1.31, 95% CI 0.82-2.11, p = 0.26) with no significant heterogeneity (I2 0%, Chi2 21.1, p = 0.51). CONCLUSION: Our study showed no difference in the rate of BNS incidence among randomized trials comparing TURP vs. Ablation vs. Enucleation and can be used as a reference to counsel patients undergoing BPH surgery.
PURPOSE: Bladder neck stenosis (BNS) is a long-term complication of surgical procedures for benign prostatic hyperplasia (BPH). We performed a systematic literature review and a meta-analysis of the incidence of BNS after transurethral procedures for BPH. METHODS: We performed a systemic literature review using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. We accepted only randomized trials comparing transurethral resection of the prostate (TURP) vs. other transurethral surgery for BPH that were grouped in Ablation vs. Enucleation modalities. The incidences of BNS were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and expressed as Risk Ratios, 95% Confidence Intervals, and p values. Study heterogeneity was assessed utilizing the I2 value. RESULTS: 72 studies were identified for meta-analysis, 46 comparing TURP vs. Ablation and 26 TURP vs. Enucleation. The pooled incidence of BNS was 1.3% after TURP, 0.66% after enucleation and 1.2% after Ablation. The incidence of BNS was higher after TURP than after Enucleation but the difference was not statistically significant (RR 1.75 95% CI 0.81-3.79, p = 0.16). There was no significant heterogeneity among the studies (I2 0%, Chi2 4.11, p = 0.90). The incidence of BNS was higher after TURP than after Ablation, but the difference was not statistically significant (RR 1.31, 95% CI 0.82-2.11, p = 0.26) with no significant heterogeneity (I2 0%, Chi2 21.1, p = 0.51). CONCLUSION: Our study showed no difference in the rate of BNS incidence among randomized trials comparing TURP vs. Ablation vs. Enucleation and can be used as a reference to counsel patients undergoing BPH surgery.
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