Evaluating transurethral resection of the prostate over twenty years: a systematic review and meta-analysis of randomized clinical trials

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Abstract

Purpose

The goal of this systematic review is to assess the temporal changes in outcomes and complications of transurethral resection of the prostate (TURP) from 2000 to 2022.

Methods

We conducted a systematic review and meta-analysis of 103 randomized clinical trials from PubMed on TURP, involving 8521 patients. Studies were grouped by years: 2000–2004, 2005–2009, 2010–2014, and 2015–2022. We assessed International Prostate Symptom Score (IPSS), Peak Flow (Qmax), Post-void residue of urine (PVR), and post-operative complications. Heterogeneity was ranked as low (I ² < 25%), moderate (I ² = 25–75%), or high (I ² > 75%).

Results

TURP significantly improved IPSS, Qmax, and PVR, with the most recent studies showing superior results in IPSS and Qmax after 3 years compared to 2000–2004 studies. Heterogeneity in PVR was high (I ² = 100%). No negative impact on erectile function was observed. Complication rates included TURP syndrome (2%), bleeding (8%), and blood transfusion (6%), but elevated heterogeneity with difference between the groups was seen in clot evacuation (I ² = 83%) and urinary tract infections (I ² = 82%). Other complications were urinary retention (4%), incontinence (8%), urethral stricture (3%), bladder neck stenosis (2%).

Conclusion

In the last 20 years there has not been a clear trend in the results of TURP. The found heterogeneity may indicate a lack of standardization in TURP procedures. However, symptomatic improvement among patients is uniform, which supports this procedure as a historical benchmark surgical treatment for BPH.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00345-024-05332-3.

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Most cited references 146

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Prostate-specific antigen as a serum marker for adenocarcinoma of the prostate.

T A Stamey, N Yang, A R Hay … (1987)

To compare the clinical usefulness of the serum markers prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP), we measured them by radioimmunoassay in 2200 serum samples from 699 patients, 378 of whom had prostatic cancer. PSA was elevated in 122 of 127 patients with newly diagnosed, untreated prostatic cancer, including 7 of 12 patients with unsuspected early disease and all of 115 with more advanced disease. The PSA level increased with advancing clinical stage and was proportional to the estimated volume of the tumor. The PAP concentration was elevated in only 57 of the patients with cancer and correlated less closely with tumor volume. PSA was increased in 86 percent and PAP in 14 percent of the patients with benign prostatic hyperplasia. After radical prostatectomy for cancer, PSA routinely fell to undetectable levels, with a half-life of 2.2 days. If initially elevated, PAP fell to normal levels within 24 hours but always remained detectable. In six patients followed postoperatively by means of repeated measurements, PSA--but not PAP--appeared to be useful in detecting residual and early recurrence of tumor and in monitoring responses to radiation therapy. Prostate massage increased the levels of both PSA and PAP approximately 1.5 to 2 times. Needle biopsy and transurethral resection increased both considerably. We conclude that PSA is more sensitive than PAP in the detection of prostatic cancer and will probably be more useful in monitoring responses and recurrence after therapy. However, since both PSA and PAP may be elevated in benign prostatic hyperplasia, neither marker is specific.

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Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients.

Oliver Reich, Christian Gratzke, Alexander Bachmann … (2008)

Transurethral resection of the prostate has for decades been the standard surgical therapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia, the most common benign neoplasm in men. To generate a contemporary reference for evolving medical and minimally invasive therapies we analyzed complications and immediate outcomes of transurethral prostate resection in a statewide multicenter study. We prospectively evaluated 10,654 patients undergoing transurethral prostate resection in the state of Bavaria, Germany from January 1, 2002 until December 31, 2003. Case records containing 54 items concerning preoperative status, operation details, complications and immediate outcome, were recorded for each patient. The mortality rate for transurethral prostate resection was 0.10%. The cumulative short-term morbidity rate was 11.1%. The most relevant complications were failure to void (5.8%), surgical revision (5.6%), significant urinary tract infection (3.6%), bleeding requiring transfusions (2.9%) and transurethral resection syndrome (1.4%). The resected tissue averaged 28.4 gm. Incidental carcinoma of the prostate was diagnosed by histological examination in 9.8% of patients. Urinary peak flow rate increased significantly to 21.6 +/- 9.4 ml per second (baseline 10.4 +/- 6.8 ml per second, 1 tail p <0.0001), while post-void residual decreased to 31.1 +/- 73.0 ml (baseline 180.3 +/- 296.9 ml, 1-tail p <0.0001). In a large scale evaluation comprising 44 mostly nonacademic urological departments in Bavaria, unique real-world data for transurethral prostate resection were prospectively generated. This most contemporary information should be of use to potential patients and facilitate subsumption of emerging surgical and nonsurgical benign prostatic hyperplasia treatment options.

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Complications of transurethral resection of the prostate (TURP)--incidence, management, and prevention.

Jens Rassweiler, Dogu Teber, Rainer Kuntz … (2006)

To update the complications of transurethral resection of the prostate (TURP), including management and prevention based on technological evolution. Based on a MEDLINE search from 1989 to 2005, the 2003 results of quality management of Baden-Württemberg, and long-term personal experience at three German centers, the incidence of complications after TURP was analyzed for three subsequent periods: early (1979-1994); intermediate (1994-1999); and recent (2000-2005) with recommendations for management and prevention. Technological improvements such as microprocessor-controlled units, better armamentarium such as video TUR, and training helped to reduce perioperative complications (recent vs. early) such as transfusion rate (0.4% vs. 7.1%), TUR syndrome (0.0% vs. 1.1%), clot retention (2% vs. 5%), and urinary tract infection (1.7% vs. 8.2%). Urinary retention (3% vs. 9%) is generally attributed to primary detrusor failure rather than to incomplete resection. Early urge incontinence occurs in up to 30-40% of patients; however, late iatrogenic stress incontinence is rare (<0.5%). Despite an increasing age (55% of patients are older than 70), the associated morbidity of TURP maintained at a low level (<1%) with a mortality rate of 0-0.25%. The major late complications are urethral strictures (2.2-9.8%) and bladder neck contractures (0.3-9.2%). The retreatment rate range is 3-14.5% after five years. TURP still represents the gold standard for managing benign prostatic hyperplasia with decreasing complication rates. Technological alternatives such as bipolar and laser treatments may further minimize the risks of this technically difficult procedure.

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Author and article information

Contributors

Hemendra N. Shah:

ORCID: http://orcid.org/0000-0002-4273-5502

drhemendrashah@yahoo.co.in , hns35@med.miami.edu

Journal

Journal ID (nlm-ta): World J Urol

Journal ID (iso-abbrev): World J Urol

Title: World Journal of Urology

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0724-4983

ISSN (Electronic): 1433-8726

Publication date (Electronic): 15 November 2024

Publication date PMC-release: 15 November 2024

Publication date (Print): 2024

Volume: 42

Issue: 1

Electronic Location Identifier: 639

Affiliations

[1 ]Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, ( https://ror.org/02dgjyy92) Miami, USA

[2 ]Spitial Thurgau AG (STGAG), Frauenfeld, Thurgau Switzerland

Author information

Joao G. Porto http://orcid.org/0000-0002-6495-1054

Ansh M. Bhatia http://orcid.org/0000-0001-6131-4837

Maria Camila Suarez Arbelaez http://orcid.org/0000-0002-0086-9174

Ruben Blachman-Braun http://orcid.org/0000-0001-9700-0805

Khushi Shah http://orcid.org/0000-0003-2879-3607

Ankur Malpani http://orcid.org/0000-0003-1498-7443

Diana Lopategui http://orcid.org/0000-0002-8620-9512

Thomas R. W. Herrmann http://orcid.org/0000-0003-4493-1301

Hemendra N. Shah http://orcid.org/0000-0002-4273-5502

Article

Publisher ID: 5332

DOI: 10.1007/s00345-024-05332-3

PMC ID: 11568034

PubMed ID: 39547977

SO-VID: ca4a7903-6fb7-4c43-96e0-2f5b061edbb3

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 5 June 2024

Date accepted : 20 October 2024

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ScienceOpen disciplines: Urology

Keywords: transurethral resection of the prostate,benign prostatic hyperplasia,enlarged prostate,lower urinary tract symptoms

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ScienceOpen disciplines: Urology

Keywords: transurethral resection of the prostate, benign prostatic hyperplasia, enlarged prostate, lower urinary tract symptoms

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Evaluating transurethral resection of the prostate over twenty years: a systematic review and meta-analysis of randomized clinical trials

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Most cited references 146

Prostate-specific antigen as a serum marker for adenocarcinoma of the prostate.

Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients.

Complications of transurethral resection of the prostate (TURP)--incidence, management, and prevention.

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