Urethral stricture following endoscopic prostate surgery: a systematic review and meta-analysis of prospective, randomized trials.

This systematic review aims to evaluate the incidence and influencing factors of urethral stricture (US) in relation to different BPH endoscopic techniques.

We performed a systematic literature review using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials.

The incidence of US was estimated through comparative studies between different endoscopic techniques. Patients were assigned into groups according to the type of surgery (enucleation, ablation and resection group). Incidences of US were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as Risk Ratio (RR), 95% Confidence Intervals (CI), and p-values.

A total of 80 studies were included for meta-analysis. The pooled incidence of US was 1.7% after enucleation, 2.1% after ablation, 3.8% after monopolar (M)-TURP and 2.1% after bipolar (B)-TURP. The incidence of US was significantly lower after Enucleation than after TURP (RR 0.58 95% CI 0.39-0.84, p = 0.004). US incidence was lower for Ablation procedures than TURP, but the difference did not reach significance (RR 0.79 95% CI 0.61-1.3, p = 0.08). However, this was significant in the subgroup of M-TURP studies (RR 0.67, 95% CI, 0.49-0.91, p = 0.01). Sub-analysis showed that the risk of US was significantly lower after Enucleation than after TURP within 12 months after surgery (RR 0.51 95% CI 0.33-0.81, p = 0.004).

The study shows an increased incidence of US after TURP compared to enucleation and ablation procedures. The main factors related to increased US incidence are the use of monopolar energy, instrument caliber and duration of postoperative catheterization.

World journal of urology. 2022 Feb 13 [Epub ahead of print]

Giacomo Maria Pirola, Daniele Castellani, Ee Jean Lim, Marcelo Langer Wroclawski, Dong Le Quy Nguyen, Marilena Gubbiotti, Emanuele Rubilotta, Vinson Wai-Shun Chan, Mariela Corrales, Esther Garcia Rojo, Thomas R W Herrmann, Jeremy Yuen-Chun Teoh, Vineet Gauhar

Department of Urology, San Giuseppe Hospital, Multimedica Group, Milano, Italy., Department of Urology, University Hospital "Ospedali Riuniti" and Polytechnic University of Marche Region, Ancona, Italy., Department of Urology, Singapore General Hospital, Singapore, Singapore., Hospital Israelita Albert Einstein, BP-A Beneficência Portuguesa de São Paulo, São Paulo, Brazil., Department of Urology, Binh Dan Hospital, Danang, Vietnam., Department of Urology, Usl Toscana Sud Est, San Donato Hospital, Arezzo, Italy., Department of Urology, A.O.U.I. Verona University, Verona, Italy., School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK., Department of Urology, Tenon Hospital, Sorbonne University, Paris, France., Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain., Department of Urology, Spital Thurgau AG (STGAG), Frauenfeld, Switzerland., Department of Surgery, S.H. Ho Urology Center, The Chinese University of Hong Kong, Hong Kong, China., Department of Urology, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore. .

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