Transurethral resection of the prostate across continents: a meta-analysis evaluating quality of gold standard in the twenty-first century - Report - MDSpire
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Transurethral resection of the prostate across continents: a meta-analysis evaluating quality of gold standard in the twenty-first century
Clinical Report: Global Meta-Analysis of TURP Quality and Outcomes in BPH Treatment
Overview
This meta-analysis of 102 randomized clinical trials involving 8,454 patients evaluates the global effectiveness and safety of transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH). Results reveal regional variations in outcomes and complications, underscoring the impact of surgeon experience and technological advancements on TURP quality.
Background
Benign prostatic hyperplasia is the leading cause of urinary obstruction in men, with TURP established as the gold standard surgical treatment since 1926. Despite the emergence of minimally invasive surgical therapies, TURP remains the benchmark against which new procedures are compared. However, TURP outcomes and complication rates vary geographically, influenced by surgeon expertise and evolving endoscopic technologies. This study systematically reviews randomized clinical trials worldwide to assess TURP's current quality and inform best practices.
Data Highlights
Parameter
Baseline
3 Months
12 Months
>=36 Months
International Prostate Symptom Score (IPSS)
Reported
Improved
Maintained
Maintained
Maximum Urine Flow Rate (Qmax)
Reported
Improved
Maintained
Maintained
Postvoid Residual Volume (PVR)
Reported
Reduced
Maintained
Maintained
Prostate-Specific Antigen (PSA)
Reported
Reduced
Maintained
Maintained
Complications (e.g., bleeding, UTI, ED)
NA
Reported with regional variation
Reported
Reported
Retreatment Rates (1 and 3 years)
NA
Reported
Reported
Reported
Key Findings
TURP remains the predominant surgical treatment for BPH globally, with 102 RCTs analyzed from Europe, Asia, Africa, and other regions.
Significant regional differences exist in TURP outcomes and complication rates, influenced by surgeon experience and technical resources.
Experienced urologists achieve higher resection volumes and better patient outcomes compared to less experienced surgeons.
Technical advancements in endoscopic equipment have reduced complication rates in some centers, though results are not uniformly reproducible.
Common complications include bleeding, urinary tract infections, erectile dysfunction, and urethral strictures, with incidence varying by region.
Retreatment rates at 1 and 3 years post-TURP remain low but differ across geographic areas.
Clinical Implications
Clinicians should recognize that TURP outcomes are closely linked to surgeon expertise and available technology, emphasizing the importance of training and resource allocation. Regional variations in complication rates highlight the need for standardized protocols and quality improvement initiatives. Continued benchmarking of new surgical techniques against TURP is essential to maintain high standards of care in BPH management.
Conclusion
This comprehensive meta-analysis confirms TURP's enduring role as the gold standard for BPH surgical treatment while revealing geographic disparities in quality and safety. Optimizing surgeon experience and adopting technological improvements can enhance patient outcomes worldwide.
References
Global Meta-Analysis on TURP Quality and Outcomes, 2023 -- Systematic Review and Regional Analysis
by Joao G. Porto, Ansh M. Bhatia, Abhishek Bhat, Maria Camila Suarez Arbelaez, Ruben Blachman-Braun, Khushi Shah, Ankur Malpani, Diana Lopategui, Thomas R. W. Herrmann, Robert Marcovich, Hemendra N. Shah
