Department of Urology, University Hospital "Ospedali Riuniti" and Polytechnic University of Marche Region, via Conca 71, 60126, Ancona, Italy.
Hospital Israelita Albert Einstein, BP-A Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
World J Urol. 2021 Nov;39(11):4073-4083. doi: 10.1007/s00345-021-03718-1. Epub 2021 May 11.
Bladder neck stenosis (BNS) is a long-term complication of surgical procedures for benign prostatic hyperplasia (BPH). We performed a systematic literature review and a meta-analysis of the incidence of BNS after transurethral procedures for BPH.
We performed a systemic literature review using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. We accepted only randomized trials comparing transurethral resection of the prostate (TURP) vs. other transurethral surgery for BPH that were grouped in Ablation vs. Enucleation modalities. The incidences of BNS were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and expressed as Risk Ratios, 95% Confidence Intervals, and p values. Study heterogeneity was assessed utilizing the I value.
72 studies were identified for meta-analysis, 46 comparing TURP vs. Ablation and 26 TURP vs. Enucleation. The pooled incidence of BNS was 1.3% after TURP, 0.66% after enucleation and 1.2% after Ablation. The incidence of BNS was higher after TURP than after Enucleation but the difference was not statistically significant (RR 1.75 95% CI 0.81-3.79, p = 0.16). There was no significant heterogeneity among the studies (I 0%, Chi 4.11, p = 0.90). The incidence of BNS was higher after TURP than after Ablation, but the difference was not statistically significant (RR 1.31, 95% CI 0.82-2.11, p = 0.26) with no significant heterogeneity (I 0%, Chi 21.1, p = 0.51).
Our study showed no difference in the rate of BNS incidence among randomized trials comparing TURP vs. Ablation vs. Enucleation and can be used as a reference to counsel patients undergoing BPH surgery.
膀胱颈狭窄（BNS）是良性前列腺增生（BPH）手术的长期并发症。我们对经尿道前列腺切除术（TURP）治疗 BPH 后 BNS 的发生率进行了系统的文献回顾和荟萃分析。
我们使用 MEDLINE、EMBASE 和 Cochrane 中央对照试验注册库进行了系统的文献回顾。我们只接受了比较 TURP 与其他经尿道治疗 BPH 的随机试验，这些试验分为消融与剜除两种方式。使用 Cochran-Mantel-Haenszel 方法，随机效应模型对 BNS 的发生率进行汇总，并以风险比（RR）、95%置信区间（95%CI）和 p 值表示。使用 I ²值评估研究异质性。
共确定了 72 项用于荟萃分析的研究，其中 46 项比较 TURP 与消融，26 项比较 TURP 与剜除。TURP 后 BNS 的总发生率为 1.3%，剜除后为 0.66%，消融后为 1.2%。TURP 后 BNS 的发生率高于剜除，但差异无统计学意义（RR 1.75，95%CI 0.81-3.79，p=0.16）。研究之间无显著异质性（I 0%，Chi² 4.11，p=0.90）。TURP 后 BNS 的发生率高于消融，但差异无统计学意义（RR 1.31，95%CI 0.82-2.11，p=0.26），且无显著异质性（I 0%，Chi² 21.1，p=0.51）。
我们的研究显示，在比较 TURP 与消融与剜除的随机试验中，BNS 发生率无差异，可作为 BPH 手术患者咨询的参考。
