Shedding light on polypragmasy of pain after transurethral prostate surgery procedures: a systematic review and meta-analysis

Abstract

Purpose and objective

To evaluate and compare the incidences of post-operative pelvic pain (PPP) in patients undergoing ablation, enucleation and conventional transurethral resection of the prostate (TURP).

Methods

A systematic review and meta-analysis was conducted according to the PRISMA guidelines. Using MEDLINE via PubMed and Cochrane CENTRAL, randomised control trials (RCTs) and observational studies reporting PPP rates post-ablation, enucleation or TURP were identified. The risk of biases (RoB) in RCTs and observation studies were assessed using the Cochrane RoB1.0 tool and the Newcastle–Ottawa Scale, respectively.

Results

62 studies were included for qualitative analysis, while 51 of them reported number of patients with PPP post-intervention. Three observational studies and 13 RCTs compared the rates of PPP in patients undergoing ablation, enucleation or TURP. The most reported types of PPP are dysuria, abdominal pain and irritative symptoms. The pooled incidence of PPP at 1-month follow-up in patients undergoing ablation, enucleation and TURP were 0.15 (95% CI 0.10–0.22), 0.09 (95% CI 0.04–0.19 and 0.10 (95% CI 0.06–0.15), respectively. PPP is no longer prevalent at 3-months and onwards post-operatively. Ablation is associated with a higher risk of PPP than enucleation (RR 2.19, 95% CI 1.04–4.62) and TURP (RR 2.40, 95% CI 1.03–5.62) in observational studies but not RCTs; and there were no significant differences in the rates of PPP upon comparison of other modalities.

Conclusion

PPP is common after transurethral benign prostatic hyperplasia surgery. Patients undergoing ablation had a higher rate of post-intervention PPP than those undergoing enucleation and TURP in observational studies.

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Data availability

All data used in this study are already published and are secondary data.

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Funding

No funding was received for this study.

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MLW contributed to Project development and Manuscript writing/editing. DC contributed to data collection and manuscript writing/editing. FLH contributed to data collection, data analysis, manuscript writing/editing. SBT contributed to data collection and manuscript writing/editing. JDC contributed to data collection and manuscript writing/editing. TH contributed to project development and manuscript writing/editing. VWSC contributed to project development, data collection, data analysis, manuscript writing/editing. JYCT contributed to project development, data collection, data analysis, manuscript writing/editing.

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Correspondence to Marcelo Langer Wroclawski.

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Wroclawski, M.L., Castellani, D., Heldwein, F.L. et al. Shedding light on polypragmasy of pain after transurethral prostate surgery procedures: a systematic review and meta-analysis. World J Urol (2021). https://doi.org/10.1007/s00345-021-03678-6

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Keywords

  • Prostatic hyperplasia
  • Prostate
  • Pain
  • Dysuria
  • Urological surgical procedures
  • Transurethral resection of prostate