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

Porto et al.'s systematic review and meta-analysis of transurethral resection of the prostate (TURP) outcomes across different regions reveals significant improvements in IPSS, Qmax, and postvoid residual (PVR) volume. However, the study is limited by high heterogeneity in PVR outcomes, with substantial variability in clot evacuation, irritative symptoms, and incontinence, suggesting inconsistencies in patient populations, methodologies, and surgical techniques. The study fails to address key confounders such as prostate size, age at surgery, and the use of antiplatelet or anticoagulant therapy, which could significantly influence TURP's outcomes. Additionally, the analysis overlooks the rise of newer treatment alternatives like endoscopic enucleation of the prostate (EEP), which offers better outcomes for high-risk patients. Despite presenting valuable data, the lack of standardization, the omission of emerging treatment options, and failure to consider clinical guidelines limit the generalizability and applicability of Porto et al.'s conclusions on TURP as the gold standard for benign prostatic obstruction.