Comparison on the efficacy and safety of bipolar transurethral vaporization of the prostate (B-TUVP) with bipolar transurethral resection of the prostate (B-TURP) for benign prostatic hyperplasia (BPH): a systematic review and meta-analysis of randomized controlled trial

Background: Bipolar Transurethral Vaporization of the Prostate (B-TUVP) is a surgical technique for Benign Prostatic Hyperplasia (BPH) patients that known for its technical reliability, short operating time, and low risk of intraoperative bleeding. However, despite these advantages, it appears to be an unpopular choice among urologists. Previous studies have produced conflicting results when comparing B-TUVP to Transurethral Resection of the Prostate (TURP), particularly bipolar TURP (B-TURP). To date, no studies have directly compared the efficacy and complications of B-TUVP and B-TURP, which using the same energy type. Therefore, the objective of this study is to compare the efficacy and potential complications of these two modalities for the treatment of BPH. Methods: The Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) were followed to perform a systematic search in six databases. The risk of bias in RCT was evaluated using the Cochrane Risk of Bias (RoB) tool version 2. The Review Manager® 5.4 software was used for analyzing all the data. Results: Six eligible RCTs were included with a total of 940 samples. International Prostate Symptom Score (IPSS), fastest flow rate (Qmax), and post void residual (PVR) were not significantly different, while the quality of life (QoL) score (SMD =-0.64; 95%CI =-1.09 –-0.18; I² = 86%) were significantly lower in B-TUVP (p < 0.05). Hemoglobin drop (SMD =-2.05; 95%CI =-2.78 –-1.31; I² = 95%), catheterization period (SMD =-1.14; 95%CI =-1.45 –-0.84; I² = 60%), and hospital stay (SMD =-0.68; 95%CI =-1.04 –-0.31; I² = 61%) were significantly lower in B-TUVP (p < 0.05). The analysis of complications did not differ significantly between the B-TUVP and B-TURP groups. Conclusion: B-TUVP had similar short-to medium-term efficacy and complications as B-TURP, with advantages in terms of significantly better QoL score, lower hemoglobin drop, shorter catheterization period and hospital stay.