title: Transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement: a quality and meta-analysis.
abstract: OBJECTIVE
  Thanks to advancements in surgical techniques and instruments, many surgical modalities have been developed to replace transurethral resection of the prostate (TURP). However, TURP remains the gold standard for the surgical treatment of benign prostatic hyperplasia (BPH). We conducted a meta-analysis on the efficacy and safety of minimally invasive surgical therapies for BPH compared with TURP.
  
  
  METHODS
  This meta-analysis used a Medline search assessing the period from 1997 to 2011. A total of 784 randomized controlled trials were identified in an electronic search. Among the 784 articles, 36 randomized controlled trials that provided the highest level of evidence (level 1b) were included in the meta-analysis. We also conducted a quality analysis of selected articles.
  
  
  RESULTS
  Only 2 articles (5.56%) were assessed as having a low risk of bias by use of the Cochrane collaboration risk of bias tool. On the other hand, by use of the Jadad scale, there were 26 high-quality articles (72.22%). Furthermore, 28 articles (77.78%) were assessed as high-quality articles by use of the van Tulder scale. Holmium laser enucleation of the prostate (HoLEP) showed the highest reduction of the International Prostate Symptom Score compared with TURP (P<0.0001). Bipolar TURP, bipolar transurethral vaporization of the prostate, HoLEP, and open prostatectomy showed superior outcome in postvoid residual urine volume and maximum flow rate. The intraoperative complications of the minimally invasive surgeries had no statistically significant inferior outcomes compared with TURP. Also, there were no statistically significant differences in any of the modalities compared with TURP.
  
  
  CONCLUSIONS
  The selection of an appropriate surgical modality for BPH should be assessed by fully understanding each patient's clinical conditions.
authors.affiliation: Department of Urology, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: Seung Wook
authors.initials: SW
authors.lastname: Lee
authors.forename: Jong Bo
authors.initials: JB
authors.lastname: Choi
authors.forename: Kyu-Sung
authors.initials: KS
authors.lastname: Lee
authors.forename: Tae-Hyoung
authors.initials: TH
authors.lastname: Kim
authors.forename: Hwancheol
authors.initials: H
authors.lastname: Son
authors.forename: Tae Young
authors.initials: TY
authors.lastname: Jung
authors.forename: Seung-June
authors.initials: SJ
authors.lastname: Oh
authors.forename: Hee Jong
authors.initials: HJ
authors.lastname: Jeong
authors.forename: Jae Hyun
authors.initials: JH
authors.lastname: Bae
authors.forename: Young-Suk
authors.initials: YS
authors.lastname: Lee
authors.forename: Joon Chul
authors.initials: JC
authors.lastname: Kim
keywords: Holmium; Lasers; Meta-analysis; Potassium titanylphosphate; Prostatic hyperplasia; Transurethral resection of prostate