Reoperation after surgical treatment for benign prostatic hyperplasia: a systematic review

Weixiang He; Ting Ding; Zhiping Niu; Chunlin Hao; Chengbin Li; Zhicheng Xu; Yuming Jing; Weijun Qin

doi:10.3389/fendo.2023.1287212

Reoperation after surgical treatment for benign prostatic hyperplasia: a systematic review

Front Endocrinol (Lausanne). 2023 Nov 9:14:1287212. doi: 10.3389/fendo.2023.1287212. eCollection 2023.

Authors

Weixiang He^#¹, Ting Ding^#², Zhiping Niu^#³, Chunlin Hao¹, Chengbin Li¹, Zhicheng Xu¹, Yuming Jing¹, Weijun Qin¹

Affiliations

¹ Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
² Department of Clinical Laboratory Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
³ Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China.

^# Contributed equally.

Abstract

Context: Surgical treatment is important for male lower urinary tract symptom (LUTS) management, but there are few reviews of the risks of reoperation.

Objective: To systematically evaluate the current evidence regarding the reoperation rates of surgical treatment for LUTS in accordance with current recommendations and guidelines.

Evidence acquisition: Eligible studies published up to July 2023, were searched for in the PubMed^® (National Library of Medicine, Bethesda, MD, USA), Embase^® (Elsevier, Amsterdam, the Netherlands), and Web of Science™ (Clarivate™, Philadelphia, PA, USA) databases. STATA^® (StataCorp LP, College Station, TX, USA) software was used to conduct the meta-analysis. Random-effects models were used to calculate the pooled incidences (PIs) of reoperation and the 95% confidence intervals (CIs).

Evidence synthesis: A total of 119 studies with 130,106 patients were included. The reoperation rate of transurethral resection of the prostate (TURP) at 1, 2, 3, and 5 years was 4.0%, 5.0%, 6.0%, and 7.7%, respectively. The reoperation rate of plasma kinetic loop resection of the prostate (PKRP) at 1, 2, 3, and 5 years was 3.5%, 3.6%, 5.7%, and 6.6%, respectively. The reoperation rate of holmium laser enucleation of the prostate (HoLEP) at 1, 2, 3, and 5 years was 2.4%, 3.3%, 5.4%, and 6.6%, respectively. The reoperation rate of photoselective vaporization of the prostate (PVP) at 1, 2, 3, and 5 years was 3.3%, 4.1%, 6.7%, and 7.1%, respectively. The reoperation rate of surgery with AquaBeam^® at 1, 2, 3, and 5 years was 2.6%, 3.1%, 3.0%, and 4.1%, respectively. The reoperation rate of prostatic artery embolization (PAE) at 1, 2, 3, and 5 years was 12.2%, 20.0%, 26.4%, and 23.8%, respectively. The reoperation rate of transurethral microwave thermotherapy (TUMT) at 1, 2, 3, and 5 years was 9.9%, 19.9%, 23.3%, and 31.2%, respectively. The reoperation rate of transurethral incision of the prostate (TUIP) at 5 years was 13.4%. The reoperation rate of open prostatectomy (OP) at 1 and 5 years was 1.3% and 4.4%, respectively. The reoperation rate of thulium laser enucleation of the prostate (ThuLEP) at 1, 2, and 5 years was 3.7%, 7.7%, and 8.4%, respectively.

Conclusion: Our results summarized the reoperation rates of 10 surgical procedures over follow-up durations of 1, 2, 3, and 5 years, which could provide reference for urologists and LUTS patients.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO, identifier CRD42023445780.

Keywords: benign prostate hyperplasia; lower urinary tract symptoms; reoperation; retreatment; surgery.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Embolization, Therapeutic*
Humans
Lower Urinary Tract Symptoms*
Male
Prostate
Prostatic Hyperplasia* / surgery
Reoperation
Transurethral Resection of Prostate* / methods
United States

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by grants from the National Natural Science Foundation of China (No. 81772734).