Giacomo Maria Pirola1, Daniele Castellani2, Ee Jean Lim3, Marcelo Langer Wroclawski4, Dong Le Quy Nguyen5, Marilena Gubbiotti6, Emanuele Rubilotta7, Vinson Wai-Shun Chan8, Mariela Corrales9, Esther García Rojo10, Thomas R W Herrmann11, Jeremy Yuen-Chun Teoh12, Vineet Gauhar13. 1. Department of Urology, San Giuseppe Hospital, Multimedica Group, Milano, Italy. 2. Department of Urology, University Hospital "Ospedali Riuniti" and Polytechnic University of Marche Region, Ancona, Italy. 3. Department of Urology, Singapore General Hospital, Singapore, Singapore. 4. Hospital Israelita Albert Einstein, BP-A Beneficência Portuguesa de São Paulo, São Paulo, Brazil. 5. Department of Urology, Binh Dan Hospital, Danang, Vietnam. 6. Department of Urology, Usl Toscana Sud Est, San Donato Hospital, Arezzo, Italy. 7. Department of Urology, A.O.U.I. Verona University, Verona, Italy. 8. School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK. 9. Department of Urology, Tenon Hospital, Sorbonne University, Paris, France. 10. Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain. 11. Department of Urology, Spital Thurgau AG (STGAG), Frauenfeld, Switzerland. 12. Department of Surgery, S.H. Ho Urology Center, The Chinese University of Hong Kong, Hong Kong, China. 13. Department of Urology, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore. vineet_gauhar@nuhs.edu.sg.
Abstract
INTRODUCTION AND OBJECTIVES: This systematic review aims to evaluate the incidence and influencing factors of urethral stricture (US) in relation to different BPH endoscopic techniques. MATERIALS AND METHODS: We performed a systematic literature review using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. The incidence of US was estimated through comparative studies between different endoscopic techniques. Patients were assigned into groups according to the type of surgery (enucleation, ablation and resection group). Incidences of US were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as Risk Ratio (RR), 95% Confidence Intervals (CI), and p-values. RESULTS: A total of 80 studies were included for meta-analysis. The pooled incidence of US was 1.7% after enucleation, 2.1% after ablation, 3.8% after monopolar (M)-TURP and 2.1% after bipolar (B)-TURP. The incidence of US was significantly lower after Enucleation than after TURP (RR 0.58 95% CI 0.39-0.84, p = 0.004). US incidence was lower for Ablation procedures than TURP, but the difference did not reach significance (RR 0.79 95% CI 0.61-1.3, p = 0.08). However, this was significant in the subgroup of M-TURP studies (RR 0.67, 95% CI, 0.49-0.91, p = 0.01). Sub-analysis showed that the risk of US was significantly lower after Enucleation than after TURP within 12 months after surgery (RR 0.51 95% CI 0.33-0.81, p = 0.004). CONCLUSION: The study shows an increased incidence of US after TURP compared to enucleation and ablation procedures. The main factors related to increased US incidence are the use of monopolar energy, instrument caliber and duration of postoperative catheterization.
INTRODUCTION AND OBJECTIVES: This systematic review aims to evaluate the incidence and influencing factors of urethral stricture (US) in relation to different BPH endoscopic techniques. MATERIALS AND METHODS: We performed a systematic literature review using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. The incidence of US was estimated through comparative studies between different endoscopic techniques. Patients were assigned into groups according to the type of surgery (enucleation, ablation and resection group). Incidences of US were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as Risk Ratio (RR), 95% Confidence Intervals (CI), and p-values. RESULTS: A total of 80 studies were included for meta-analysis. The pooled incidence of US was 1.7% after enucleation, 2.1% after ablation, 3.8% after monopolar (M)-TURP and 2.1% after bipolar (B)-TURP. The incidence of US was significantly lower after Enucleation than after TURP (RR 0.58 95% CI 0.39-0.84, p = 0.004). US incidence was lower for Ablation procedures than TURP, but the difference did not reach significance (RR 0.79 95% CI 0.61-1.3, p = 0.08). However, this was significant in the subgroup of M-TURP studies (RR 0.67, 95% CI, 0.49-0.91, p = 0.01). Sub-analysis showed that the risk of US was significantly lower after Enucleation than after TURP within 12 months after surgery (RR 0.51 95% CI 0.33-0.81, p = 0.004). CONCLUSION: The study shows an increased incidence of US after TURP compared to enucleation and ablation procedures. The main factors related to increased US incidence are the use of monopolar energy, instrument caliber and duration of postoperative catheterization.
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