Transurethral surgery for benign prostatic hyperplasia with detrusor underactivity

According to a recent study, transurethral surgery can enhance the symptoms experienced by individuals with benign prostatic hyperplasia (BPH) and detrusor underactivity (DU). Additionally, surgical intervention offers benefits that surpass those of pharmacological approaches for BPH patients with DU. The results of this study were documented in the journal Systematic Reviews.
The search for relevant evidence involved three databases (Embase, PubMed, and Web of Science) from their inception to May 1, 2023. Different transurethral surgical procedures include photoselective vaporization of the prostate (PVP), transurethral incision of the prostate (TUIP), and transurethral prostatectomy (TURP). The efficacy of the surgical intervention was assessed according to international prostate symptom score (IPSS), maximal flow rate on uroflowmetry (Qmax), maximal detrusor pressure at maximal flow rate (PdetQmax), quality of life (QoL), postvoid residual (PVR), voided volume, and bladder contractility index (BCI). Mean differences from pooled data were utilized for comparison, while the quality of research studies was evaluated using the Newcastle-Ottawa Scale. Sensitivity analysis and funnel plots were utilized to identify potential biases. 
A total of 1142 patients were included from 10 different studies. For patients with BPH and DU, significant enhancements in IPSS (pooled MD, -14.29; 95% confidence interval, -16.67-11.90; P value < 0.05), Qmax (pooled MD, 4.79; 95% confidence interval, 2.43-7.16; P value < 0.05), QoL (pooled MD, -1.57; 95% confidence interval, -2.37-0.78; P value < 0.05), BCI (pooled MD, 23.59; 95% confidence interval, 8.15-39.04; P value < 0.05), voided volume (pooled MD, 62.19; 95% confidence interval, 17.91-106.48; P value < 0.05) and PdetQmax (pooled MD, 28.62; 95% confidence interval, 6.72-50.52; P value < 0.05) were noted within six months post-surgery. 
Additionally, significant improvements in IPSS (pooled MD, -13.76; 95% confidence interval, -15.17-12.35; P value < 0.05), Qmax (pooled MD, 6.75; 95% confidence interval, 4.35-9.15; P value < 0.05), PVR (pooled MD, -179.78; 95% confidence interval , -185.12-174.44; P value < 0.05), PdetQmax (pooled MD, 27.94; 95% confidence interval, 11.70-44.19; P value < 0.05), and QoL (pooled MD, -2.61; 95% confidence interval, -3.12-2.09; P value < 0.05) were observed after more than one year. When compared to DU patients who did not undergo surgery, those who did showed greater improvements in PdetQmax (pooled MD, -8.00; 95% confidence interval, -14.68-1.32; P value < 0.05) and PVR (pooled MD, 137.00; 95% confidence interval, 6.90-267.10; P value < 0.05). 
Thus, it can be concluded that BPH and DU symptoms can be improved through transurethral surgery. Additionally, surgical intervention offers benefits that are superior to pharmacological methods for BPH patients with DU.