Comparative analysis of the long-term efficacy and safety of minimally invasive simple prostatectomy and endoscopic enucleation of the prostate for large benign prostatic hyperplasia (>80 mL).

Abstract

Minimally invasive simple prostatectomy (MISP) and endoscopic enucleation of the prostate (EEP) are appropriate candidates for the large prostate. However, their comparative effectiveness and safety remain unclear. This study aims to conduct a comprehensive analysis comparing the efficacy and safety of MISP and EEP. We conducted a systematic search of the PubMed, Embase, and Cochrane Library databases to identify eligible studies comparing MISP and EEP. Data analysis was performed using Review Manager 5.3. Risk of bias was assessed with the ROBINS-I and the ROB2.0 assessment tool. The results of analyzing 13 studies involving 2271 patients showed that EEP had significant lower operative time (MD [CI]: 41.59 [14.62-68.56]), catheterization time (MD [CI]: 4.35 [3.31-5.38]), length of stay (MD [CI]: 2.16 [0.70-3.61]), and Hb decreases (MD [CI]: 0.46 [0.06-0.87]). MISP demonstrated significantly better long-term (MD [CI]: -0.46 [-0.89; -0.03]) and short-term QoL (MD [CI]: -0.38 [-0.66; -0.10]) and short-term Qmax (MD [CI]: 2.04 [0.06-4.03]). Efficacy outcomes were comparable in postoperative IPSS, PVR and PSA between MISP and EEP procedures. No significant differences were observed in resection weight, overall complications, blood transfusions, or urinary incontinence between MISP and EEP. Overall, EEP and MISP are both effective treatment options for large-volume BPH, providing comparable efficacy outcomes and long-term maintenance. EEP, on the other hand appears to have better perioperative outcomes, but it has a higher rate of short-term postoperative incontinence.