title: A Systematic Review and Meta-analysis of Functional Outcomes and Complications Following Transurethral Procedures for Lower Urinary Tract Symptoms Resulting from Benign Prostatic Obstruction: An Update.
abstract: BACKGROUND
  A number of transurethral ablative techniques based on the use of innovative medical devices have been introduced in the recent past for the surgical treatment of benign prostatic obstruction (BPO).
  
  
  OBJECTIVE
  To conduct a systematic review of the literature and a meta-analysis of available randomized controlled trials (RCTs), and to evaluate the efficacy and safety of transurethral ablative procedures for BPO.
  
  
  METHODS
  A systematic literature search was performed for all RCTs comparing any transurethral surgical technique for BPO to another between 1992 and 2013. Efficacy was evaluated after a minimum follow-up of 1 yr based on International Prostate Symptom Score, maximum flow rate, and postvoid residual volume. Efficacy at midterm follow-up, prostate volume, perioperative data, and short-term and long-term complications were also assessed. Data were analyzed using RevMan software.
  
  
  RESULTS
  A total of 69 RCTs (8517 enrolled patients) were included. No significant difference was found in terms of short-term efficacy between bipolar transurethral resection of the prostate (B-TURP) and monopolar transurethral resection of the prostate (M-TURP). However, B-TURP was associated with a lower rate of perioperative complications. Better short-term efficacy outcomes, fewer immediate complications, and a shorter hospital stay were found after holmium laser enucleation of the prostate (HoLEP) compared with M-TURP. Compared with M-TURP, GreenLight photoselective vaporization of the prostate (PVP) was associated with a shorter hospital stay and fewer complications but no different short-term efficacy outcomes.
  
  
  CONCLUSIONS
  This meta-analysis shows that HoLEP is associated with more favorable outcomes than M-TURP in published RCTs. B-TURP and PVP have resulted in better perioperative outcomes without significant differences regarding efficacy parameters after short-term follow-up compared with M-TURP. Further studies are needed to provide long-term comparative data and head-to head comparisons of emerging techniques.
  
  
  RESULTS
  Bipolar transurethral resection of the prostate, photovaporization of the prostate, and holmium laser enucleation of the prostate have shown efficacy outcomes comparable with conventional techniques yet reduce the complication rate. The respective role of these new options in the surgical armamentarium needs to be refined to propose tailored surgical treatment for benign prostatic obstruction relief.
authors: Department of Urology, Tenon Hospital, University Paris 6, Assistance Publique-Hopitaux de Paris, Paris, France. Electronic address: jeannicolas.cornu@gmail.com.
authors: Jean-Nicolas
authors: JN
authors: Cornu
authors: Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
authors: Sascha
authors: S
authors: Ahyai
authors: Department of Urology, University Hospital Basel, Basel, Switzerland.
authors: Alexander
authors: A
authors: Bachmann
authors: Department of Urology, AMC University Hospital, Amsterdam, The Netherlands.
authors: Jean
authors: J
authors: de la Rosette
authors: Department of Urology, Tauranga Hospital, Tauranga, New Zealand.
authors: Peter
authors: P
authors: Gilling
authors: Department of Urology, Urologische Klinik und Poliklinik, Klinikum der Universität München-Großhadern, Munich, Germany.
authors: Christian
authors: C
authors: Gratzke
authors: Department of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA.
authors: Kevin
authors: K
authors: McVary
authors: Department of Surgery, Oncology, and Gastroenterology-Urology Clinic, University of Padua, Padua, Italy.
authors: Giacomo
authors: G
authors: Novara
authors: Department of Urology, Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, Australia.
authors: Henry
authors: H
authors: Woo
authors: Department of Urology and Andrology, Kaiser-Franz-Josef Spital, Vienna, Austria.
authors: Stephan
authors: S
authors: Madersbacher
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D053844:Lasers, Solid-State / Q000627:therapeutic use; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011467:Prostate / Q000473:pathology / Q000601:surgery*; D011470:Prostatic Hyperplasia / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D020728:Transurethral Resection of Prostate / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D001748:Urinary Bladder Neck Obstruction / Q000209:etiology / Q000601:surgery*; D014835:Volatilization
keywords: Benign prostatic obstruction; Laser; Meta-analysis; Prostate; Transurethral procedures