Transurethral resection of the prostate across continents: a meta-analysis evaluating quality of gold standard in the twenty-first century.

Purpose: To compare outcomes of transurethral resection of the prostate (TURP) across different regions worldwide over the past two decades.

Methods: A systematic review and meta-analysis of randomized clinical trials indexed to PubMed that assessed TURP. A total of 102 studies with 8,454 patients were included and grouped by continents: Europe, Asia, Africa, and Others (North America, South America, and Australia). International Prostate Symptom Score (IPSS), peak flow (Qmax), postvoid residual urine (PVR), PSA levels, prostate volume, and Sexual Health Inventory for Men scores (at 3, 12, and 36 months) were assessed, along with postoperative complications. Heterogeneity across studies was classified as low (I < 25%), moderate (I = 25-75%), or high (I > 75%).

Results: TURP consistently exhibited significant enhancements in IPSS, Qmax, and PVR across various regions. Notably, PVR demonstrated high heterogeneity (I²=100%). TURP presented low complication rates with TURP syndrome (2%), bleeding (8%), and blood transfusion (6%). However, significant heterogeneity was observed, particularly for clot evacuation (I = 87%), irritative symptoms (I = 96%), and incontinence (I = 84%). The retreatment rates at 1 and 3 years were 5% and 7%, respectively, with significant differences across regions.

Conclusion: Global outcomes of TURP lack a discernible trend. The substantial heterogeneity observed among continents suggests a lack of standardization. Nevertheless, uniform symptomatic improvements among patients still support TURP as the gold-standard surgical treatment for benign prostatic hyperplasia, despite variations in its results worldwide.