Introduction

Pharmacological and surgical modalities are currently used in the treatment of benign prostatic hyperplasia (BPH) patients with detrusor underactivity (DU). However, the efficacy of pharmacological intervention is not satisfactory, and the efficacy of surgical treatment remains controversial. Hence there is an urgent need to summarize the findings of the relevant literature. Transurethral surgical treatment includes transurethral prostatectomy (TURP), photoselective vaporization of the prostate (PVP), Holmium laser enucleation of the prostate (HoLEP) and transurethral incision of the prostate (TUIP).

Aim

To assess the efficacy of various surgical interventions in BPH patients with DU.

Method

Study Design

• Systematic review and meta-analysis of published literature

Treatment Strategy

• A comprehensive electronic data search was conducted using PubMed, Embase, and Web of Science
• The studies which evaluated the efficacy of surgical treatments on BPH patients with DU were selected
• The efficacy of the transurethral surgical treatment was assessed based on various urodynamic parameters
• Pooled mean differences (MDs) were used for comparison
• The Newcastle–Ottawa Scale was used to analyze the quality of enrolled studies
• Potential for possible biases were evaluated using sensitivity analysis and funnel plots

Endpoints

• Maximal flow rate on uroflowmetry (Q_max)
• International Prostate Symptom Score (IPSS)
• Postvoid residual (PVR)
• Quality of life (QoL)
• Voided volume
• Bladder contractility index (BCI)
• Maximal detrusor pressure at maximal flow rate (PdetQ_max)

Results

• Meta-analysis included 10 studies with a total of 1142 patients
• Significant improvements in BPH patients with DU were observed within half a year after surgery as seen in Table 1; p<0.05 for all
• After more than 1 year, there were remarkable elevations in Q_max , BCI and PdetQ_max (p < 0.05 for all)
• IPSS, PVR, and QoL were significantly reduced; (p < 0.05 for all) as seen in Table 1.

  Table 1. Comparison of outcomes within 6 months and at >1 year

  	Pooled Mean Difference within 6 months	Pooled Mean Difference at >1 year
  Qmax	4.79	6.75
  IPSS	-14.29	-13.76
  QoL	-1.57	-2.61
  BCI	23.59	39.22
  PdetQmax	28.62	27.94

   

• DU patients who received surgery demonstrated higher PVR (pooled MD, 137.00; p < 0.05) and lower PdetQ_max (pooled MD, − 8.00; p < 0.05) as compared to those who did not receive surgery

 Conclusion

• Transurethral surgery can improve the symptoms of benign prostatic hyperplasia (BPH) patients with detrusor underactivity (DU).
• Surgery resulted in significant improvement in the urodynamic parameters and quality-of-life within half an year.
• The benefits were seen even after more than 1-year post-surgery.

Syst Rev. 2024; 13: 93. Doi: 10.1186/s13643-024-02514-3