Mac Curtain Benjamin M, Abbasi Behzad, Leng Lynn, Maremanda Ankith, Carlisle Marvin, Hakam Nizar, Li Kevin, Faris Anna, Frankiewicz Mikołaj, Breyer Benjamin N
Department of Urology, University of California, San Francisco, CA, USA.
The Smith Institute for Urology at Lenox Hill Hospital, Northwell Health, New York, United States.
Int Urol Nephrol. 2025 Jul 11. doi: 10.1007/s11255-025-04648-2.
To systematically evaluate the incidence of bladder neck contracture (BNC) following surgical treatments for benign prostate hyperplasia (BPH).
A systematic search of PubMed, Embase, and CENTRAL was conducted to identify randomized, prospective trials reporting BNC following BPH surgery up to October 29, 2024. Eligible studies included adults, compared two surgical methods, and had at least two years of follow-up, to ensure adequate time for BNC development. Proportions were pooled and risk ratios were produced using random effects models.
Eleven studies comprising 1,536 patients with 2-year follow-up were included. The pooled incidence of BNC following all included BPH surgeries was 3% (95% CI 2-5). The BNC rate was 9% (95% CI 4-15) for photosensitive photo-selective vaporization of the prostate (PVP), 3% (95% CI 2-5) for transurethral resection of the prostate (TURP), and 3% (95% CI 1-5) for holmium laser enucleation of the prostate (HoLEP). TURP and HoLEP were not associated with an increased risk of BNC compared to alternative treatments including transurethral incision of the prostate, HoLEP, PVP, thulium laser resection of the prostate, diode laser vaporization of the prostate or laparoscopic simple prostatectomy for TURP, and TURP, open prostatectomy, and bipolar enucleation of the prostate for HoLEP. We observed log risk ratios, regarding BNC formation, of 0.19 (95% CI - 0.70 to 1.08) and - 0.34 (95% CI - 1.41 to 0.73), for TURP and HoLEP, respectively. Smaller prostate size and anticoagulant use were linked to BNC formation. The preferred treatment for BNC was bladder neck/prostate incision or re-resection.
BNC is a relatively uncommon complication following surgical treatment for BPH. HoLEP and TURP are not associated with an increased risk of BNC compared to other methods of surgical treatment, while smaller prostate size may be a potential risk factor. Further research is needed to identify modifiable factors and assess outcomes of emerging treatments.
系统评估良性前列腺增生（BPH）手术治疗后膀胱颈挛缩（BNC）的发生率。
对PubMed、Embase和CENTRAL进行系统检索，以确定截至2024年10月29日报道BPH手术后BNC的随机、前瞻性试验。符合条件的研究包括成年人，比较了两种手术方法，并进行了至少两年的随访，以确保有足够的时间让BNC发生。使用随机效应模型汇总比例并计算风险比。
纳入了11项研究，共1536例患者，随访2年。所有纳入的BPH手术术后BNC的汇总发生率为3%（95%可信区间2%-5%）。前列腺光敏选择性汽化术（PVP）的BNC发生率为9%（95%可信区间4%-15%），经尿道前列腺切除术（TURP）为3%（95%可信区间2%-5%），钬激光前列腺剜除术（HoLEP）为3%（95%可信区间1%-5%）。与包括经尿道前列腺切开术、HoLEP、PVP、铥激光前列腺切除术、二极管激光前列腺汽化术或用于TURP的腹腔镜单纯前列腺切除术，以及用于HoLEP的TURP、开放性前列腺切除术和双极前列腺剜除术等替代治疗相比，TURP和HoLEP与BNC风险增加无关。我们观察到，对于TURP和HoLEP，BNC形成的对数风险比分别为0.19（95%可信区间-0.70至1.08）和-0.34（95%可信区间-1.41至0.73）。较小的前列腺体积和使用抗凝剂与BNC形成有关。BNC的首选治疗方法是膀胱颈/前列腺切开或再次切除。
BNC是BPH手术治疗后相对少见的并发症。与其他手术治疗方法相比，HoLEP和TURP与BNC风险增加无关，而较小的前列腺体积可能是一个潜在风险因素。需要进一步研究以确定可改变的因素并评估新出现治疗方法的效果。
