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Meta-Analysis
. 2024 Mar 22;13(1):93.
doi: 10.1186/s13643-024-02514-3.

Transurethral surgical treatment for benign prostatic hyperplasia with detrusor underactivity: a systematic review and meta-analysis

Peilin Zou #  1   2   3 , Chang Liu #  1 , Yucong Zhang  1   2 , Chao Wei  4 , Xiaming Liu  4 , Shengfei Xu  4 , Qing Ling  4 , Zhong Chen  4 , Guanghui Du  4 , Xiaoyi Yuan  5
Affiliations
Meta-Analysis

Transurethral surgical treatment for benign prostatic hyperplasia with detrusor underactivity: a systematic review and meta-analysis

Peilin Zou et al. Syst Rev. .

Abstract

Background: The efficacy of surgical treatment for benign prostatic hyperplasia (BPH) patients with detrusor underactivity (DU) remains controversial.

Methods: To summarize relevant evidence, three databases (PubMed, Embase, and Web of Science) were searched from database inception to May 1, 2023. Transurethral surgical treatment modalities include transurethral prostatectomy (TURP), photoselective vaporization of the prostate (PVP), and transurethral incision of the prostate (TUIP). The efficacy of the transurethral surgical treatment was assessed according to maximal flow rate on uroflowmetry (Qmax), International Prostate Symptom Score (IPSS), postvoid residual (PVR), quality of life (QoL), voided volume, bladder contractility index (BCI) and maximal detrusor pressure at maximal flow rate (PdetQmax). Pooled mean differences (MDs) were used as summary statistics for comparison. The quality of enrolled studies was evaluated by using the Newcastle-Ottawa Scale. Sensitivity analysis and funnel plots were applied to assess possible biases.

Results: In this study, 10 studies with a total of 1142 patients enrolled. In BPH patients with DU, within half a year, significant improvements in Qmax (pooled MD, 4.79; 95% CI, 2.43-7.16; P < 0.05), IPSS(pooled MD, - 14.29; 95%CI, - 16.67-11.90; P < 0.05), QoL (pooled MD, - 1.57; 95% CI, - 2.37-0.78; P < 0.05), voided volume (pooled MD, 62.19; 95% CI, 17.91-106.48; P < 0.05), BCI (pooled MD, 23.59; 95% CI, 8.15-39.04; P < 0.05), and PdetQmax (pooled MD, 28.62; 95% CI, 6.72-50.52; P < 0.05) were observed after surgery. In addition, after more than 1 year, significant improvements were observed in Qmax (pooled MD, 6.75; 95%CI, 4.35-9.15; P < 0.05), IPSS(pooled MD, - 13.76; 95%CI, - 15.17-12.35; P < 0.05), PVR (pooled MD, - 179.78; 95%CI, - 185.12-174.44; P < 0.05), QoL (pooled MD, - 2.61; 95%CI, - 3.12-2.09; P < 0.05), and PdetQmax (pooled MD, 27.94; 95%CI, 11.70-44.19; P < 0.05). Compared with DU patients who did not receive surgery, DU patients who received surgery showed better improvement in PVR (pooled MD, 137.00; 95%CI, 6.90-267.10; P < 0.05) and PdetQmax (pooled MD, - 8.00; 95%CI, - 14.68-1.32; P < 0.05).

Conclusions: Our meta-analysis results showed that transurethral surgery can improve the symptoms of BPH patients with DU. Surgery also showed advantages over pharmacological treatment for BPH patients with DU.

Systematic review registration: PROSPERO CRD42023415188.

Keywords: Detrusor underactivity; Meta-analysis; Systematic review; Transurethral surgical treatment.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow diagram for studies included in and excluded from the meta-analysis
Fig. 2
Fig. 2
The comparison of each value of DU patients before and after surgery within half a year. A Qmax, maximal flow rate on uroflowmetry. B IPSS, International Prostate Symptom Score. C PVR, post-void residual. D QoL, quality of life. E Voided volume. F BCI, bladder contractility index. G PdetQmax, maximal detrusor pressure at maximal flow rate
Fig. 3
Fig. 3
The comparison of each value of DU patients before and after surgery for more than a year. A Qmax, maximal flow rate on uroflowmetry. B IPSS, International Prostate Symptom Score. C PVR, post-void residual. D QoL, quality of life. E Voided volume. F BCI, bladder contractility index. G PdetQmax, maximal detrusor pressure at maximal flow rate
Fig. 4
Fig. 4
The comparison of each value of DU patients undergoing surgery or not with 135.6 months follow-up. A Qmax, maximal flow rate on uroflowmetry. B IPSS, International Prostate Symptom Score. C PVR, post-void residual. D QoL, quality of life. E Voided volume. F BCI, bladder contractility index. G PdetQmax, maximal detrusor pressure at a maximal flow rate
Fig. 5
Fig. 5
The sensitivity analysis of each value of DU patients before and after surgery within half a year. A Qmax, maximal flow rate on uroflowmetry. B IPSS, International Prostate Symptom Score. C PVR, post-void residual. D QoL, quality of life. E BCI, bladder contractility index. F PdetQmax, maximal detrusor pressure at a maximal flow rate
Fig. 6
Fig. 6
The sensitivity analysis of each value of DU patients before and after surgery more than a year. A Qmax, maximal flow rate on uroflowmetry. B IPSS, International Prostate Symptom Score. C PVR, post-void residual. D QoL, quality of life; E. BCI, bladder contractility index. F PdetQmax, maximal detrusor pressure at maximal flow rate
Fig. 7
Fig. 7
The funnel plot of each value of DU patients before and after surgery within half a year. A Qmax, maximal flow rate on uroflowmetry. B IPSS, International Prostate Symptom Score. C PVR, post-void residual. D QoL, quality of life. E voided volume. F BCI, bladder contractility index. G PdetQmax, maximal detrusor pressure at maximal flow rate
Fig. 8
Fig. 8
The funnel plot of each value of DU patients before and after surgery for more than a year. A Qmax, maximal flow rate on uroflowmetry. B IPSS, International Prostate Symptom Score. C PVR, post-void residual. D QoL, quality of life. E Voided volume. F BCI, bladder contractility index. G PdetQmax, maximal detrusor pressure at maximal flow rate
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