Bladder neck contracture post-treatment for benign prostatic hyperplasia: a systematic review and meta-analysis of randomized clinical studies.

PURPOSE: To systematically evaluate the incidence of bladder neck contracture (BNC) following surgical treatments for benign prostate hyperplasia (BPH).

METHODS

A systematic search of PubMed, Embase, and CENTRAL was conducted to identify randomized, prospective trials reporting BNC following BPH surgery up to October 29, 2024. Eligible studies included adults, compared two surgical methods, and had at least two years of follow-up, to ensure adequate time for BNC development. Proportions were pooled and risk ratios were produced using random effects models.

RESULTS

Eleven studies comprising 1,536 patients with 2-year follow-up were included. The pooled incidence of BNC following all included BPH surgeries was 3% (95% CI 2-5). The BNC rate was 9% (95% CI 4-15) for photosensitive photo-selective vaporization of the prostate (PVP), 3% (95% CI 2-5) for transurethral resection of the prostate (TURP), and 3% (95% CI 1-5) for holmium laser enucleation of the prostate (HoLEP). TURP and HoLEP were not associated with an increased risk of BNC compared to alternative treatments including transurethral incision of the prostate, HoLEP, PVP, thulium laser resection of the prostate, diode laser vaporization of the prostate or laparoscopic simple prostatectomy for TURP, and TURP, open prostatectomy, and bipolar enucleation of the prostate for HoLEP. We observed log risk ratios, regarding BNC formation, of 0.19 (95% CI - 0.70 to 1.08) and - 0.34 (95% CI - 1.41 to 0.73), for TURP and HoLEP, respectively. Smaller prostate size and anticoagulant use were linked to BNC formation. The preferred treatment for BNC was bladder neck/prostate incision or re-resection.

CONCLUSIONS

BNC is a relatively uncommon complication following surgical treatment for BPH. HoLEP and TURP are not associated with an increased risk of BNC compared to other methods of surgical treatment, while smaller prostate size may be a potential risk factor. Further research is needed to identify modifiable factors and assess outcomes of emerging treatments.