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Bladder neck stenosis after transurethral prostate surgery: a systematic review and meta-analysis

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Abstract

Purpose

Bladder neck stenosis (BNS) is a long-term complication of surgical procedures for benign prostatic hyperplasia (BPH). We performed a systematic literature review and a meta-analysis of the incidence of BNS after transurethral procedures for BPH.

Methods

We performed a systemic literature review using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. We accepted only randomized trials comparing transurethral resection of the prostate (TURP) vs. other transurethral surgery for BPH that were grouped in Ablation vs. Enucleation modalities. The incidences of BNS were pooled using the Cochran–Mantel–Haenszel Method with the random effect model and expressed as Risk Ratios, 95% Confidence Intervals, and p values. Study heterogeneity was assessed utilizing the I2 value.

Results

72 studies were identified for meta-analysis, 46 comparing TURP vs. Ablation and 26 TURP vs. Enucleation. The pooled incidence of BNS was 1.3% after TURP, 0.66% after enucleation and 1.2% after Ablation. The incidence of BNS was higher after TURP than after Enucleation but the difference was not statistically significant (RR 1.75 95% CI 0.81–3.79, p = 0.16). There was no significant heterogeneity among the studies (I2 0%, Chi2 4.11, p = 0.90). The incidence of BNS was higher after TURP than after Ablation, but the difference was not statistically significant (RR 1.31, 95% CI 0.82–2.11, p = 0.26) with no significant heterogeneity (I2 0%, Chi2 21.1, p = 0.51).

Conclusion

Our study showed no difference in the rate of BNS incidence among randomized trials comparing TURP vs. Ablation vs. Enucleation and can be used as a reference to counsel patients undergoing BPH surgery.

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Data availability

Data available on request from the authors.

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Authors and Affiliations

  1. Department of Urology, University Hospital “Ospedali Riuniti” and Polytechnic University of Marche Region, via Conca 71, 60126, Ancona, Italy

    Daniele Castellani & Andrea Benedetto Galosi

  2. Hospital Israelita Albert Einstein, BP–A Beneficência Portuguesa de São Paulo, São Paulo, Brazil

    Marcelo Langer Wroclawski

  3. Faculdade de Medicina do ABC, Santo André, Brazil

    Marcelo Langer Wroclawski

  4. Department of Urology, San Donato Hospital, Arezzo, Italy

    Giacomo Maria Pirola & Marilena Gubbiotti

  5. Ng Teng Fong General Hospital (NUHS), Singapore, Singapore

    Vineet Gauhar

  6. Department of Urology, A.O.U.I. Verona University, Verona, Italy

    Emanuele Rubilotta

  7. School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK

    Vinson Wai-Shun Chan

  8. Department of Surgery, United Christian Hospital, Hong Kong, China

    Bryan Kwun-Chung Cheng

  9. Department of Urology, Spital Thurgau AG (STGAG), Frauenfeld, Switzerland

    Thomas R. W. Herrmann

  10. S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China

    Jeremy Yuen-Chun Teoh

Authors
  1. Daniele Castellani
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  2. Marcelo Langer Wroclawski
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  3. Giacomo Maria Pirola
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  5. Emanuele Rubilotta
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  6. Vinson Wai-Shun Chan
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  8. Marilena Gubbiotti
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  9. Andrea Benedetto Galosi
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  10. Thomas R. W. Herrmann
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  11. Jeremy Yuen-Chun Teoh
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Contributions

DC: project development, data management, statistics, data analysis, graphics illustration, manuscript writing and editing; JYCT: project development, data management, data analysis, manuscript editing; TRWH and ABG: manuscript editing, supervision; MLW: project development, data management, manuscript writing; ER, GMP, MG, VG, and BKCC: data management, manuscript writing; VWSC: data management, data analysis.

Corresponding author

Correspondence to Jeremy Yuen-Chun Teoh.

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Conflict of interest

D. Castellani, M. L. Wroclawski, G.M. Pirola, V. Gauhar, E. Rubilotta, V. W-S Chan, B. K-C Cheng, M. Gubbiotti, A. B. Galosi, and J. Y-C. Teoh have no conflicts of interest to declare. T. R. W. Herrmann is company consultant for Karl Storz.

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Castellani, D., Wroclawski, M.L., Pirola, G.M. et al. Bladder neck stenosis after transurethral prostate surgery: a systematic review and meta-analysis. World J Urol 39, 4073–4083 (2021). https://doi.org/10.1007/s00345-021-03718-1

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  • DOI: https://doi.org/10.1007/s00345-021-03718-1

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