Objective To perform a systematic review to assess the incidence of transient (<6-month) and persistent (>6-month) stress (SUI), urge (UUI), and mixed urinary incontinence (MUI) after transurethral surgeries for benign prostatic hyperplasia (BPH). Materials and Methods A systematic literature search was performed using Embase, PubMed, and Web of Science. We included studies comparing monopolar(M)/bipolar(B) TURP vs ablation vs enucleation procedures. Incidence of incontinence was assessed using Cochran-Mantel-Haenszel Method and reported as odds ratio (OR), 95% confidence interval (CI), and p-values. Statistical significance was set at p <0.05 Evidence synthesis 28 studies were included. Incidence of transient SUI was 4.6%, 6.0%, 3.0%, 2.4% after ablation, enucleation, M-TURP, and B-TURP, respectively. Incidence of persistent SUI was 1.1% after ablation, 1.7%, after enucleation and M-TURP, 1.0% after B-TURP. Incidence of transient UUI was 2.0%, 7.3%, 4.4%, 2.8% after ablation, enucleation, M-TURP, and B-TURP, respectively. Incidence of persistent UUI was 2.2% after M-TURP. The incidence of transient MUI was 5.1%, 0.8%, 5.4%, 0.9% after ablation, enucleation, M-TURP, and B-TURP, respectively. Incidence of persistent MUI was 3.1% after ablation, and 4.8% after M-TURP. Incidence of transient and persistent SUI and UUI did not differ after TURP vs enucleation. Incidence of transient (OR 3.32, 95% CI 0.41-26.65, p=0.26) and persistent SUI (OR 4.79, 95%CI 0.52-43.89,p=0.17) was not significantly higher after ablation. Incidence of transient UUI was not significantly higher after ablation (OR 2.62, 95%CI 0.04-166.01,p=0.65), whilst persistent UUI did not differ. Incidence of transient MUI was significantly higher after enucleation (OR 3.26, 95%CI 1.51-7.05,p=0.003). Incidence of transient and persistent MUI did not differ after TURP vs ablation. Conclusions Ablation, enucleation, and TURP have an impact on all forms of incontinence but this is transient in most cases with no difference between the groups, except for MUI which was higher after enucleation vs M-TURP.
Journal of endourology. 2022 May 19 [Epub ahead of print]
Daniele Castellani, Emanuele Rubilotta, Andrea Fabiani, Martina Maggi, Marcelo Wroclawski, Jeremy Y C Teoh, Giacomo Maria Pirola, Marilena Gubbioti, Maria Pia Pavia, Fernando Gomez Sancha, Andrea Benedetto Galosi, Vineet Gauhar
AOU Ospedali Riuniti di Ancona, 18494, via conca 71, Ancona, Italy, 60126; ., Azienda Ospedaliera Universitaria Integrata Verona, 9286, Urology, Verona, Veneto, Italy; ., ASUR Area Vasta 3 Macerata, 125697, Macerata, Marche, Italy; ., Sapienza University of Rome, 9311, Department of Maternal-Infant and Urological Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Viale del Policlinico 155, Roma, Lazio, Italy, 00161; ., Hospital Israelita Albert Einstein, Urology, Sao Paulo, Sao Paulo, Brazil; ., Prince of Wales Hospital, Surgery, 30-32 Ngan Shing Street, Shatin, New Territories., Hong Kong, Hong Kong; ., Viale Borri,57Varese, Italy, 21100; ., San Donato Hospital, 47669, Urology, Arezzo, Toscana, Italy; ., ASUR Area Vasta 4 Fermo, 165362, Dept of Urology, Porto San Giorgio, Italy; ., Clinica Cemtro, Av. ventisquero de la condesa 42, Madrid, Spain, Urology, Ventisquero de la Condesa 42, Madrid, Madrid, Spain, 28034; ., Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, 18494, Urology, Via Conca, Ancona, Marche, Italy, I-60100., Ng Teng Fong General Hospital, 242949, Urology, Singapore, Singapore; .