Effect of Preoperative Urodynamic Detrusor Underactivity on Transurethral Surgery for Benign Prostatic Hyperplasia: A Systematic Review and Meta-Analysis

Purpose We investigated the effect of preoperative urodynamic detrusor underactivity on the transurethral surgery outcomes of benign prostatic hyperplasia. Materials and Methods We systematically searched the online PubMed®, Embase® and Cochrane Library databases for articles published between January 1989 and June 2017. Results A total of 10 articles met the eligibility criteria for this systematic review. The eligible studies included a total of 1,113 patients with a median of 73 per study (range 40 to 382). Five of the 10 studies involved conventional transurethral prostatectomy and 5 described laser surgery. In patients with detrusor underactivity the pooled mean difference was significant for the poorer I-PSS (International Prostate Symptom Score) (pooled mean difference −3.73, 95% CI −5.65–−1.80 for 9 studies and 936 participants) and maximal flow rate improvement (pooled mean difference −3.92, 95% CI −4.85–−3.00 for 8 studies and 951 participants) but not for quality of life score (pooled mean difference −0.15, 95% CI −0.56–0.25 for 7 studies and 858 participants) or post-void residual volume (pooled mean difference −5.57, 95% CI −20.65–9.50 for 9 studies and 971 participants). Some comparisons showed interstudy heterogeneity despite strict selection criteria for the included studies. However, there was no clear evidence of publication bias in this meta-analysis. Conclusions Our meta-analysis results showed that preoperative detrusor underactivity correlated with poorer I-PSS and maximal flow rate improvement. Preoperative urodynamic detrusor underactivity is a valuable finding for excluding patients who are inappropriate candidates for transurethral surgery.