@article{eedd8ef78f874f46843682520812cba7,
title = "Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement",
abstract = "Context: There is a continuous decline in the number of transurethral resections of the prostate (TURP) and an increase use of minimally invasive surgical therapy (MIST) for lower urinary tract symptoms resulting from benign prostatic enlargement. Current results from randomised controlled trials (RCT) and methodologically sound prospective studies suggest that some of the proposed procedures have the potential to replace TURP. Objective: To determine the contemporary status of TURP and of the currently most commonly applied transurethral MISTs: (1) bipolar TURP, (2) bipolar transurethral vaporisation of the prostate (bipolar TUVP), (3) holmium laser enucleation of the prostate (HoLEP), and (4) potassium-titanyl-phosphate (KTP) laser vaporisation of the prostate. Evidence acquisition: This meta-analysis was based on a systematic Medline search assessing the period 1997-2009. All RCTs comparing TURP and the most commonly discussed ablative treatments were included. The end points of our analyses were functional outcomes and treatment-related adverse events. Evidence synthesis: Twenty-seven publications involving 23 different RCTs with a total of 2245 patients provided the highest level of evidence available (level 1b) and were fully assessed. Meta-analysis was conducted with SAS v.9.1.3 (SAS Institute, Cary, NC, USA). Forest plots were produced using the R software. Pooled odds ratios and 95% confidence intervals were calculated between various operative techniques versus TURP. Functional results between the specific transurethral procedures versus TURP were summarised as differences in means. Conclusions: This meta-analysis demonstrates statistically comparable efficacy and overall morbidity for MISTs versus contemporary TURP. Type, category (minor vs major), and the number of complications (safety profile) vary specifically for each of the different transurethral techniques. We feel that the individual patient's clinical profile should be carefully assessed to identify the most appropriate transurethral technique.",
keywords = "Benign prostatic enlargement, Bipolar TURP, Bipolar TUVP, Diode-laser, GreenLight-laser, HoLEP, Holmiumlaser, Hyperplasia and obstruction, KTP, LUTS, Meta-analysis, Minimal invasive surgical therapy, PVP, TURP, Thulium-laser, Tissue ablation, Vaporisation",
author = "Ahyai, {Sascha A.} and Peter Gilling and Kaplan, {Steven A.} and Kuntz, {Rainer M.} and Stephan Madersbacher and Francesco Montorsi and Speakman, {Mark J.} and Stief, {Christian G.}",
note = "Funding Information: This meta-analysis demonstrates statistically comparable efficacy and overall morbidity for MISTs versus contemporary TURP, although only a limited number of RCTs and few long-term data are available. However, type, category (minor vs major), and the number of complications (safety profile) vary specifically for each of the different transurethral techniques used for the treatment of clinical BPE. This might be a meaningful advantage over TURP in selected patients. Hence, TURP seems to loose its monopoly. We feel that after considering the patient{\textquoteright}s performance status, medication, prostate size, and personal expectations, the selection of the most appropriate transurethral technique for the individual patient must be of the utmost importance. Still, more evidence in terms of RCTs and longer follow-up is desirable for bipolar TUVP and GreenLight laser and essential for the very recently introduced techniques (eg, thulium laser ablation or enucleation of the prostate). Innovative techniques need to be performed as part of randomised studies; otherwise, our urologic armamentarium might be changed by an “early-adopter bias” of aggressive marketing of novel techniques. Bipolar TURP and HoLEP passed the phase of feasibility. For bipolar TURP, further long-term data are still warranted to define its place in contemporary BPE management. For HoLEP, the next step is its broader clinical application outside of experienced centres, ideally, under the mentorship of established HoLEP surgeons to generally shorten the learning curve. Author contributions: Sascha A. Ahyai had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Ahyai, Gilling, Kaplan, Kuntz, Madersbacher, Montorsi, Speakman, Stief. Acquisition of data: Ahyai, Gilling, Kaplan, Kuntz, Madersbacher, Montorsi, Speakman, Stief. Analysis and interpretation of data: Ahyai, Gilling, Kaplan, Kuntz, Madersbacher, Montorsi, Speakman, Stief. Drafting of the manuscript: Ahyai, Gilling, Kaplan, Kuntz, Madersbacher, Montorsi, Speakman, Stief. Critical revision of the manuscript for important intellectual content: Ahyai, Gilling, Kaplan, Kuntz, Madersbacher, Montorsi, Speakman, Stief. Statistical analysis: Ahyai, Gilling, Kaplan, Kuntz, Madersbacher, Montorsi, Speakman, Stief. Obtaining funding: None. Administrative, technical, or material support: Ahyai, Gilling, Kaplan, Kuntz, Madersbacher, Montorsi, Speakman, Stief. Supervision: Ahyai, Gilling, Kaplan, Kuntz, Madersbacher, Montorsi, Speakman, Stief. Other (specify): None. Financial disclosures: I certify that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: Peter Gilling is a meeting participant for Lumenis and Boston Scientific. Rainer Kuntz is a meeting participant for Lumenis. Funding/Support and role of the sponsor: None. ",
year = "2010",
month = sep,
doi = "10.1016/j.eururo.2010.06.005",
language = "English",
volume = "58",
pages = "384--397",
journal = "European Urology",
issn = "0302-2838",
publisher = "Elsevier",
number = "3",
}