Presented by: Joao Porto MD
Desai Sethi Urology Institute, University of Miami

Introduction

To assess differences between TURP results in distinct parts of the world and comprehend the variations of this procedure in the last decades.

Materials

 A systematic review and meta-analysis of PubMed from 2000 to 2022 were conducted to assess randomized clinical trials (RCT) related to TURP. We found 126 studies with 8431 patients that were divided by continents: Europe, Asia, Africa, and Others (North America, South America, and Australia). The articles were also divided based on year period: 2000-2004, 2005-2009, 2010-2014, and 2015-2022. We assessed baseline and follow-up visits (3, 12, and 36-months) for International Prostate Symptom Score, Peak Flow (Qmax), Post-void residue of urine (PVR), Prostate-Specific Antigen (PSA), prostate volume, Sexual Health Inventory for Men (SHIM) score, and post-operative complications. We evaluated the overall heterogeneity (OH) of all studies in the analysis, differences between continents and year-groups, and heterogeneity within each continent and year-group.

Results

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We found high OH for Qmax at 3 and 12-months, PVR during the entire follow-up, and PSA at 3-months. We also found significant elevated OH for bleeding, clot evacuation, incontinence, irritative symptoms, retrograde ejaculation, UTI, and diagnosis of cancer. Significant differences were found between continents for Qmax at 12-months, PVR at 12 and 36-months, SHIM at 3-months, PSA at 3 and 36-months, and prostate volume at 3 and 12-months. Significant continent differences were also found for bleeding, blood transfusion, clot evaluation, and cancer diagnosis. Furthermore, Europe had significantly higher heterogeneity compared to other continents.

Conclusion

In the last 20 years there has not been a clear trend in the results of TURP. The heterogeneity within continents may indicate a lack of standardization in TURP, however, the symptom improvement among patients is relatively uniform, what may explain why TURP is the best available option for BPH, even with variation in the way it is performed across different regions.

Funding

N/A

Co-Authors

Ansh Bhatia,
Seth GS Medical College and KEM Hospital

Abhishek Bhat, MD
Desai Sethi Urology Institute, University of Miami

Maria Camila Suarez Arbelaez, MD
Desai Sethi Urology Institute, University of Miami

Ruben Blachman-Braun, MD
Desai Sethi Urology Institute, University of Miami

Hemendra Shah, MD
Desai Sethi Urology Institute, University of Miami