Tang Yin, Li Jinhong, Pu Chuanxiao, Bai YunJin, Yuan HaiChao, Wei Qiang, Han Ping
Department of Urology, West China Hospital, Sichuan University , Chengdu, P.R. China .
J Endourol. 2014 Sep;28(9):1107-14. doi: 10.1089/end.2014.0188. Epub 2014 Jun 5.
To evaluate the efficacy and safety of monopolar (M-TURP) and bipolar (B-TURP) transurethral resection of the prostate in benign prostatic hypertrophy (BPH) patients.
Eligible randomized controlled trials (RCTs) were identified from electronic databases without language restrictions. Database search, quality assessment, and data extraction were independently performed. The primary postoperative outcomes of topical M-TURP and B-TURP were maximum flow rate (Qmax) and/or International Prostate Symptom Score (IPSS). Safety was estimated by TUR syndrome; need for transfusion; clot retention; bladder neck contracture (BNC); urethral stricture (US); and catheter removal time. Efficacy and safety were investigated using the Review Manager.
Thirty-one trials met the inclusion criteria. Pooled analysis revealed significant difference in efficacy between the M-TURP and B-TURP groups. Safety analysis revealed significant improvement in the TUR syndrome with B-TURP than with M-TURP. Pooled analysis revealed that clot retention was significantly higher in M-TURP than in B-TURP. Moreover, pooled analysis revealed no significant difference between both groups in the blood transfusion frequency or late complications (urethral strictures) and bladder neck constriction.
This systematic review indicates that B-TURP was significantly better in the result of Qmax and for decreasing the incidence of TUR syndrome and clot retention. No significant differences were observed in the nature of adverse events such as transfusions, retention after catheter removal, and urethral complications between both groups. Thus, B-TURP is the next generation "gold standard" for benign prostatic obstruction (BPO) because it is associated with a lower rate of clinically relevant complications such as TUR syndrome and clot retention.
评估单极经尿道前列腺切除术（M-TURP）和双极经尿道前列腺切除术（B-TURP）治疗良性前列腺增生（BPH）患者的疗效和安全性。
从电子数据库中检索符合条件的随机对照试验（RCT），无语言限制。独立进行数据库检索、质量评估和数据提取。M-TURP和B-TURP术后的主要结局指标为最大尿流率（Qmax）和/或国际前列腺症状评分（IPSS）。通过经尿道电切综合征评估安全性；输血需求；血块残留；膀胱颈挛缩（BNC）；尿道狭窄（US）；以及导尿管拔除时间。使用RevMan软件对疗效和安全性进行研究。
31项试验符合纳入标准。汇总分析显示M-TURP组和B-TURP组在疗效上存在显著差异。安全性分析显示，与M-TURP相比，B-TURP的经尿道电切综合征有显著改善。汇总分析显示，M-TURP的血块残留率显著高于B-TURP。此外，汇总分析显示两组在输血频率或晚期并发症（尿道狭窄）和膀胱颈狭窄方面无显著差异。
本系统评价表明，B-TURP在改善最大尿流率以及降低经尿道电切综合征和血块残留发生率方面显著更优。两组在输血、拔管后残留及尿道并发症等不良事件的性质上未观察到显著差异。因此，B-TURP是良性前列腺梗阻（BPO）的下一代“金标准”，因为它与经尿道电切综合征和血块残留等临床相关并发症的发生率较低有关。
