Transurethral Resection of the Prostate Across Continents: A Meta-Analysis Evaluating Quality of Gold Standard in the Twenty-First Century

Benign prostatic hyperplasia (BPH) has been managed with a variety of surgical techniques over the decades. However, no procedure has demonstrated enduring success comparable to transurethral resection of the prostate (TURP), which remains the gold standard for surgical treatment, being an essential component of urology training, and continues to serve as a benchmark against which newer techniques are evaluated.

Despite its longstanding efficacy, the academic focus in recent years has shifted towards alternative treatments, leading to a relative decline in research dedicated to TURP. While innovation is crucial for the advancement of urology, continuous evaluation of established procedures remains equally important to ensure the highest quality of patient care.

Recognizing this need, we conducted an extensive meta-analysis, "Transurethral Resection of the Prostate Across Continents: A Meta-analysis Evaluating the Quality of the Gold Standard in the Twenty-first Century." This study aimed to provide a contemporary evaluation of TURP outcomes by systematically analyzing randomized controlled trials published over the last two decades. A total of 102 studies encompassing 8,454 patients were analyzed, categorizing results by continent to identify regional variations in clinical outcomes, complication rates, and overall effectiveness.

Our findings reaffirm TURP’s effectiveness in improving lower urinary tract symptoms, demonstrating significant enhancements in IPSS, Qmax, and PVR across all regions. The procedure was also associated with low rates of serious complications. However, our analysis revealed substantial heterogeneity among different continents, suggesting variations in surgical techniques, patient selection, and healthcare system influences.

While our study provides updated global data on TURP, inherent limitations exist in any meta-analysis, including variability in study designs, surgeon expertise, and institutional protocols. Nevertheless, the insights gained emphasize the need for ongoing evaluation and standardization of TURP practices worldwide. By systematically assessing its outcomes on a global scale, we reinforce its role as a critical surgical technique while paving the way for further studies aimed at optimizing patient care.

Written by: Joao G. Porto, MD, & Hemendra Shah, MD,

Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL

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