The Efficacy And Safety Of Surgical Treatments For Large Volume Benign Prostatic Hyperplasia

Objective:To evaluate the efficacy and safety of different surgical treatments for large volume BPH.Method:The PubMed,EMBASE,Cochrane databases and references of included articles were searched to obtain eligible randomized controlled trials(RCTs)which compared the different approaches for large volume BPH up to November 2020.We extracted the baseline characteristic,IPSS,QoL,Qmax,operation time,hospital stay and catheterization after treatment,Hgb decrease,rate of recatheterization or urinary retention,rate of transient incontinence after catheter removal,rate of urethral stricture or bladder-neck contracture of the included literatures and analyzed them with ADDIs and Stata software.Results:22 RCTs with a total of 2480 participants were included in this network meta-analysis,10 surgical treatments were evaluated.The results of this NMA showed that,TUERP achieved better IPSS,QoL and Qmax at 12 months after surgical treatment,meanwhile,the perioperative Hgb decrease of TUERP was the lowest.OP obtained the most removal prostate tissue and TURP was the worst one from the view of rank probability,however,OP was inferior to other operation methods in the aspect of catheterization,hospital stay and Hgb decrease.There was no significant statistical difference among the ten surgical procedures in operation time.In terms of the incidence of perioperative adverse events and postoperative complications,the rank probability results indicated that TURP and OP had the higher perioperative transfusion rate.The ranking of transient urinary incontinence after TURP was the best,but the ranking of urethral stricture,bladder-neck contracture after TURP was the worst.Conclusion:Based on the analysis results,we recommend TUERP as the primary choice for patients with large volume BPH.TUERP is superior to other methods in effective outcomes at 12 months after treatment,but specific situations should be considered when surgeons make a decision.