For BPH, bipolar, monopolar transurethral resection of the prostate show similar clinical efficacy

Milan, Italy-In the treatment of BPH, while both bipolar-transurethral resection of the prostate (B-TURP) and monopolar-TURP (M-TURP) have similar clinical efficacy, B-TURP is associated with fewer adverse events, according to a recent systematic review of the two modalities.

“We found that the clinical effectiveness of the two procedures was similar, but the safety profile of B-TURP was better. We think that B-TURP is preferable because of comparatively fewer adverse events,” said first author Muhammad Imran Omar, MBBS, MD, MSc, research fellow at the Academic Urology Unit of the University of Aberdeen, Aberdeen, United Kingdom, who presented the results at the European Association of Urology annual congress in Milan, Italy.

The current review updated a Health Technology Assessment (HTA) systematic review that was conducted in 2006, and which reported on alternative approaches to endoscopic ablation for BPH, based on reports from 1966 to 2006. The updated evaluation included the earlier HTA studies as well as pertinent reports extending up to 2012 that focused exclusively on comparing B-TURP with M-TURP.

The investigators carried out electronic database searches on MEDLINE, Embase, CENTRAL (Central Register of Controlled Trials), and the Science Citation Index, including only randomized controlled trials that compared B-TURP with M-TURP. Clinical efficacy was quantified by the International Prostate Symptom Score (IPSS), Quality of Life (QoL) score, and maximum flow rate (Qmax). They also extracted data on adverse events, including transurethral resection (TUR) syndrome, blood transfusion, clot retention, incontinence, erectile dysfunction, urethral stricture, re-operation, urinary tract infection, and acute urinary retention. Additionally, two reviewers independently assessed the risk of bias and the quality of evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.

Twenty-four trials comparing M-TURP with B-TURP (six from HTA systematic review and 18 from the updated search) were included in this review. The electronic database search initially identified 949 abstracts. Of the 94 full-text articles that were then assessed for eligibility, 18 studies met the inclusion criteria.

No statistically significant differences in QoL

The review found no statistically significant differences in IPSS and QoL scores between B-TURP and M-TURP. The results were statistically significant for Qmax at 3 months (p<.00001), 6 months (p=.0001), and 12 months (p<.00001) in favor of B-TURP. Although the results for Qmax were statistically significant, there was evidence of statistical heterogeneity, resulting in clinically insignificant results, suggesting no overall difference in clinical efficacy between B-TURP and M-TURP, Dr. Omar reported.

B-TURP was shown to cause fewer adverse events than M-TURP, including TUR syndrome, with a risk ratio of 0.12 (95% CI: 0.05, 0.31, p<.00001); clot retention, with a risk ratio of 0.48 (95% CI: 0.30, 0.77, p=.002); and blood transfusion, with a risk ratio of 0.53 (95% CI: 0.35, 0.82, p=.004).

The risk of bias assessment revealed methodologic limitations, and the majority of the trials (22/24) had a short follow-up (≤1 year). Most of the assessed outcomes were of moderate quality. Dr. Omar recommended further study using well-designed, controlled trials, which use the recommendations of CONSORT (Consolidated Standards of Reporting Trials) statement.UT

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