A systematic review and meta-analysis of the safety and efficacy of endoscopic enucleation and non-enucleation procedures for benign prostatic enlargement

• Published in: World journal of urology Vol. 38; no. 7; pp. 1663 - 1684
• Main Authors: Wroclawski, Marcelo Langer, Teles, Saulo Borborema, Amaral, Breno Santos, Kayano, Paulo Priante, Cha, Jonathan Doyun, Carneiro, Arie, Alfer, Wladimir, Monteiro, Jose, Gil, Antonio Otero, Lemos, Gustavo Caserta
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-07-2020; Springer Nature B.V
• Subjects: Catheterization; Clinical trials; Endoscopy; Endoscopy - adverse effects; Enlargement; Enucleation; Humans; Intubation; Literature reviews; Male; Medicine; Medicine & Public Health; Meta-analysis; Nephrology; Oncology; Original Article; Patients; Prostate; Prostatectomy - adverse effects; Prostatectomy - methods; Prostatic Hyperplasia - surgery; Quality of life; Randomized Controlled Trials as Topic; Safety; Surgery; Treatment Outcome; Urology; Outcomes assessments; Prostate; Endoscopic surgical procedures
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-019-02968-4

Introduction and objective
This study aims to evaluate safety and efficacy of different endoscopic enucleation of the prostate (EEP) techniques, by comparing laser (L-EEP) and non-laser (NL-EEP) procedures; and EEP versus other endoscopic non-enucleation (ENE) surgeries for benign prostatic enlargement (BPE).
Methods
A systematic literature review was performed for randomized clinical trials (RCT) that compared different endoscopic treatments for BPE, between 1982 and 2018. Two analyses were performed: (1) EEP versus ENE; and (2) L-EEP versus NL-EEP. Efficacy was assessed using perioperative data (removed tissue volume, operation time (OT), catheterization time, length of hospital stay); and functional outcomes [IPSS, IIEF-5, maximum flow rate (Qmax), postvoid residual volume (PVR), quality of life (QoL)]. Safety was assessed through complications (Hb and sodium decrease, transfusion rate). Meta-analyses were performed using RevMan
®
5.3.
Results
Out of 35 RCTs (4066 patients), 31 (3909 patients) evaluated EEP versus ENE, and 4 (327 patients) evaluated L-EEP versus NL-EEP. EEP presented greater Qmax. Also, EEP presented less catheterization time, length of hospital stay, Hb decrease, transfusion rate. OT and bladder injury were greater with EEP. There were no significant differences between other items. L-EEP removed more tissue volume, with a smaller drop in serum Hb. There were no significant differences in other perioperative data, functional outcomes, complications.
Conclusions
EEP and ENE are effective and safe for treating BPE. Perioperative data favors EEP. Statistical differences, with questionable clinical significance in functional outcomes and complication rates were encountered. L-EEP provides greater tissue removal and smaller Hb decrease then NL-EEP, with similar functional profiles.