Effect of urodynamic preoperative detrusor overactivity on the outcomes of transurethral surgery in patients with male bladder outlet obstruction: a systematic review and meta-analysis

To investigate the effect of urodynamic detrusor overactivity (DO) on the outcomes of transurethral surgery in patients with male bladder outlet obstruction (BOO). We systematically searched the PubMed, Embase, and Cochrane Library databases for articles published between January 1989 and June 2017. All results of eligible studies were synthesized. Nine articles met the eligibility criteria. These studies included a total of 932 patients with a median number of 92 patients per study (range 40-190). Of the nine studies, the conventional transurethral prostatectomy was adopted in four studies, photoselective vaporization of prostate in three studies, and other surgical modalities in two studies. In patients with DO positive, the pooled mean difference (MD) was not significant for a better or poorer improvement in the International Prostate Symptom Score [pooled MD, - 0.27; 95% confidence interval (CI), - 1.75 to 1.22; studies, 9; participants, 827], quality-of-life score (pooled MD, - 0.14; 95% CI, - 0.46 to 0.18; studies, 7; participants, 734), maximal flow rate (pooled MD, 0.79; 95% CI, - 1.57 to 3.14; studies, 8; participants, 781), and post-void residual volume (pooled MD, 2.81; 95% CI, - 4.70 to 10.32; studies, 6; participants, 509) compared to patients with DO negative. Some comparisons showed between-study heterogeneity despite the strict criteria of the eligible studies. However, there was no clear evidence of publication bias in the funnel plots. Our meta-analysis results demonstrated that preoperative urodynamic DO has no diagnostic role in the prediction of surgical outcomes in patients with male BOO.