Surgical outcome of anatomical endoscopic enucleation of the prostate: A systemic review and meta-analysis.

Abstract

An increasing number of evidences demonstrate the safety and efficacy of endoscopic enucleation of the prostate (EEP) using various energy devices. We performed a systemic literature search for all relevant randomised controlled trials (RCTs) comparing any EEP technique with TURP or open prostatectomy (OP). A total of 21 RCTs with 2,957 patients were included; the majority were studies of holmium laser or bipolar diathermy. Compared to TURP, EEP resulted in greater improvement in IPSS (MD: -0.56, 95% CI: -0.90 to -0.23), PVR (MD: -2.24, 95% CI: -4.45 to -0.03) and Qmax (MD: -1.07, 95% CI: -1.53 to -0.61). EEP was associated with more prostate tissue removed (MD: -9.73, 95% CI: -15.71 to -3.75), less haemoglobin loss (MD: -0.47, 95% CI: -0.70 to -0.23), shorter catheterisation time (MD: -22.82, 95% CI: -30.11 to -15.52) and shorter length of hospitalisation (MD: -1.05, 95% CI: -1.33 to -0.78). Compared to OP, EEP resulted in equivalent functional outcomes. However, EEP was associated with less haemoglobin loss (MD: -1.17, 95% CI: -1.98 to -0.37), shorter catheterisation time (MD: -89.74, 95% CI: -112.60 to -66.88) and shorter length of hospitalisation (MD: -3.91, 95% CI: -4.63 to -3.60). The current evidence supports that EEP can be considered as a new standard of the surgical management for BPH.