Clinical Report: Two-Decade Meta-Analysis of TURP Outcomes in BPH Management

Overview

This comprehensive meta-analysis of 103 randomized clinical trials involving 8,521 patients over two decades demonstrates that transurethral resection of the prostate (TURP) remains an effective surgical treatment for benign prostatic hyperplasia (BPH). Improvements in symptom scores and urinary flow rates have been sustained long-term, with recent studies showing enhanced outcomes and reduced complications compared to earlier periods.

Background

Benign prostatic hyperplasia is a common cause of bladder outlet obstruction in men, traditionally managed surgically by TURP, considered the gold standard. Despite the emergence of minimally invasive surgical therapies and enucleation techniques, TURP remains widely used due to its efficacy, availability, and cost-effectiveness. Over the past two decades, technological and procedural advancements have aimed to improve TURP safety and outcomes, though variability in results has been noted, potentially influenced by surgeon experience and evolving practice patterns.

Data Highlights

Key Findings

• TURP consistently reduces International Prostate Symptom Score (IPSS) by approximately 15-16 points at 3 months, 1 year, and beyond 3 years postoperatively.
• Maximum urine flow rate (Qmax) improves by about 11-13 ml/s across all time points, with significant enhancement in studies from 2010 onwards.
• Postvoid residual volume (PVR) decreases substantially after TURP, with sustained reductions at long-term follow-up.
• Recent studies (2010–2022) report better functional outcomes compared to earlier periods, indicating improvements in surgical technique and technology.
• Complication rates have decreased over time, although specific perioperative complication data were not fully detailed in the excerpt.
• The rate of incidental prostate cancer detection and retreatment at 1 and 3 years were evaluated but specific results were not provided in the summary.

Clinical Implications

Clinicians can continue to consider TURP as a reliable and effective surgical option for BPH, with evidence supporting sustained symptom relief and improved urinary flow over long-term follow-up. Advances in surgical techniques and equipment over the past two decades have enhanced outcomes and may reduce complication rates. Patient selection should consider individual factors such as prostate size and anticoagulation status, given TURP’s limitations.

Conclusion

This meta-analysis confirms that TURP remains a cornerstone in BPH surgical management, demonstrating consistent and durable improvements in urinary symptoms and flow rates over more than 20 years. Ongoing technological and procedural refinements have contributed to better outcomes in recent years.

References

1. Comprehensive Review and Meta-Analysis of RCTs on TURP, 2000–2022