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Minerva Urology and Nephrology 2021 Jul 26

DOI: 10.23736/S2724-6051.21.04530-4


lingua: Inglese

Emerging minimally invasive transurethral treatments for benign prostatic hyperplasia: a systematic review with meta-analysis of functional outcomes and description of complications

Celeste MANFREDI 1 , Davide ARCANIOLO 1, Pietro SPATAFORA 2, Fabio CROCEROSSA 3, Ferdinando FUSCO 1, Paolo VERZE 4, Cristian FIORI 5, Rocco DAMIANO 3, Luca CINDOLO 6, Marco DE SIO 1, Javier R. OTERO 7, 8

1 Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy; 2 Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy; 3 Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy; 4 Department of Medicine, Surgery, Dentistry Scuola Medica Salernitana, University of
Salerno, Salerno, Italy; 5 Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy; 6 Department of Urology, Villa Stuart Private Hospital, Rome, Italy; 7 Department of Urology, Hospital Universitario 12 Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; 8 Unit of Urology, HM Hospitales, Montepríncipe, Puerta del Sur, Sanchinarro, Madrid, Spain

INTRODUCTION: Several minimally invasive surgical procedures have been proposed as alternative therapies for benign prostatic hyperplasia (BPH). The present systematic review aimed to describe the functional outcomes and complications of emerging minimally invasive transurethral treatments for BPH.
EVIDENCE ACQUISITION: A comprehensive bibliographic search on the MEDLINE and Cochrane Library databases was conducted. No chronological restriction was applied. Retrospective and prospective primary studies were included. A meta-analysis of IPSS, IPSS-QoL, Qmax, and PVR was performed. Data on adverse events were presented narratively.
EVIDENCE SYNTHESIS: A total of 18 studies were included. Thirteen papers were eligible for the meta-analysis. iTIND, Rezūm, and Aquablation were associated with a significant improvement in IPSS (p<0.001), IPSS-QoL (p<0.001), and Qmax (p<0.001) compared to baseline. A significant reduction of PVR from baseline was found with Rezūm (p<0.001) and Aquablation (p<0.001) but not iTIND (p=0.22). A significant difference in IPSS, IPSS-QoL, and Qmax was shown in favor of Aquablation compared to Rezūm and iTIND (p<0.001). Rezūm and iTIND were mainly associated with mild to moderate adverse effects. Hematuria or bleeding was reported in all studies regarding Aquablation (0.8%-26%), the need for transfusion or intervention for bleeding varied between 1.8% and 9%.
CONCLUSIONS: Aquablation, Rezūm, and iTIND significantly improve urinary functional outcomes compared to baseline; however, Aquablation would seem to lead to better functional results compared to the other procedures. Rezūm and iTIND appear to have an excellent safety profile, while Aquablation would seem to expose patients to a nonnegligible risk of bleeding.

KEY WORDS: BPH; Minimally invasive; Aquablation; iTIND; Rezūm

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