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

Wroclawski, Marcelo Langer; Teles, Saulo Borborema; Amaral, Breno Santos; Kayano, Paulo Priante; Doyun, Jonathan; Carneiro, Ariê; Alfer, Wladimir; Monteiro, Jose; Gil, Antônio Otero; Lemos, Gustavo Caserta

doi:10.1007/s00345-019-02968-4

Cited by 18 publications

(25 citation statements)

References 44 publications

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“…(2019) revealed EEP achieved better functional outcomes (Qmax and IPSS) than resection and vapourisation methods at 6 and 12 months post‐operatively, and the difference remained significant 24 and 36 months after the operation. While the criteria of enrolment were a little different across these studies and the present study, our results were generally in line with the findings of the above studies (Arcaniolo et al., 2019; Huang et al., 2019; Wroclawski et al., 2019), suggesting that EEP has become a new standard of the surgical treatment for BPH. There are some limitations in the current study.…”

Section: Discussionsupporting

confidence: 91%

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

et al. 2020

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Benign prostatic hyperplasia (BPH) is the most common aetiology of bladder outlet obstruction and lower urinary tract symptoms (LUTS) in men. While medical treatment is considered as the first-line treatment for male LUTS secondary to BPH, a substantial portion of men would require surgical intervention because of insufficient relief of LUTS with medications or having any absolute indication for surgery, such as recurrent or refractory urinary retention, recurrent urinary tract infections, bladder stones or diverticula, or dilatation of the upper urinary tract due to BPH, with or without renal insufficiency (Foster et al., 2019; Oelke et al., 2013). By removing the hyperplastic prostate tissue, the surgery can restore normal urine flow, relieve the LUTS, and avoid bladder dysfunction and damages to the upper urinary tract. Transurethral resection of prostate (TURP) and open prostatectomy (OP) have been traditionally considered as the gold standard of the surgical management for BPH (Foster et al., 2019; Oelke et al., 2013). TURP is currently the most common surgical modality for BPH with a medium to large prostate. It is generally effective in relieving the outlet obstruction. However, in TURP the prostate is resected in a piece-by-piece fashion, and bleeding may arise from any cutting. This usually requires repeated coagulation and is time-consuming. These facts significantly limit the efficiency of TURP and therefore usually prohibits a complete resection, especially in cases with a huge prostate. On the other hand, OP can simply achieve complete removal

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Section: Discussionsupporting

confidence: 91%

“…A meta‐analysis by Wroclawski et al. (2019) demonstrated that EEP resulted in better functional outcomes (PSS, Qmax and PVR) and more favourable perioperative outcomes as compared to nonenucleation endoscopic procedures. Similarly, a recent network meta‐analysis by Huang et al.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…Endoscopic Enucleation of the Prostate (EEP) was first described by Hiraoka, 1983 and is as an excellent approach to surgically treat LUTS due to BPH. The anatomical EEP (aEEP) allegedly presents the same safety profile as the best endoscopic nonenucleating procedures (Wroclawski et al., 2019) and the same long‐term functional outcomes as SP. It can also be safely performed in patients using anticoagulants and/or antiplatelet medications (El Tayeb, Jacob, Bhojani, Bammerlin, & Lingeman, 2016).…”

Section: Introductionmentioning

confidence: 99%

Anatomical endoscopic enucleation of the prostate: The next gold standard? No! (or not yet!)

2020

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Most cases of lower urinary tract symptoms due to benign prostatic hyperplasia are initially managed through medical therapy. In cases that surgery is indicated, the anatomical endoscopic enucleation of the prostate (aEEP), first described in 1983, allegedly presents the same safety profile as the best endoscopic non-enucleating procedures and the same long-term functional outcomes as simple prostatectomy. Thus, why aEEP has not yet been consolidated as the gold-standard BPH surgical treatment? The main reasons are as follows: (a) Multiple energy sources and techniques; (b) High costs; (c) Steep learning curve; (d) Rare in-residency training; (e) Reimbursement issues; (f) Outcomes and (g) Complications. We do believe aEEP is an important advance and a "practice-changing" procedure that will play an important role in the BPH surgical options arsenal, especially for larger prostates. However, there is a need to start an in-residency training program, with a mentor guidance, and, over time, the cost will likely be reduced due to greater competition between companies and greater support from health insurers. Considering these points, in the future, EEP may be considered the gold-standard treatment for BPH… but not yet. K E Y W O R D S endoscopic surgical procedure, prostate, prostatic hyperplasia, standard of care, urologic surgical procedures How to cite this article: Wroclawski ML, Teles SB, Carneiro A. Anatomical endoscopic enucleation of the prostate: The next gold standard? No! (or not yet!). Andrologia.

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“…A meta‐analysis comparing AEEP procedures to endoscopic nonenucleation procedures (ENE) reports statistically significant advantages for AEEP in terms of IPSS, Qmax and PVR; however, the clinical significance of these findings is questionable as they are modest: IPSS superiority of 0.29 to 1.44 points, Qmax superiority of 0.26 to 1.87 ml/s, and PVR superiority of −3.69 to −14.98 ml (Wroclawski et al, 2019). There was no significant difference between AEEP and ENE in terms of improvement in quality of life (QoL) scores.…”

Section: At Least Equivalent If Not Better Improvements In Symptom Smentioning

confidence: 99%

“…RTs and meta‐analyses consistently report less bleeding and consequently shorter catheter times and hospital stays for AEEP in comparison to TURP. A recent meta‐analysis reports less of a decrease in serum haemoglobin (−0.54mg/dl, 95% CI [−0.97, −0.20], p < .005), fewer blood transfusions (OR 0.83, 95% CI [0.21, 0.67], p < .005), shorter catheter time (−0.58 days, 95% CI [−0.89, −0.28], p < .05) and shorter hospital stay (−0.91 days, 95% CI [−1.22, −0.60], p < .005), for AEEP compared to resection techniques (Wroclawski et al, 2019).…”

Section: Less Bleeding and Shorter Catheter Time And Hospital Stay Tmentioning

confidence: 99%

Anatomical endoscopic enucleation of the prostate: The next gold standard? Yes!

2020

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Anatomical endoscopic enucleation of the prostate (AEEP) was first described by Haraoka (Haraoka, 1983). It was not until Fraundorfer and Gilling reported their initial experience with Holmium Laser Enucleation of the Prostate (HoLEP) in 1998 that the potential advantages of AEEP began to be appreciated (Fraundorfer & Gilling, 1998). AEEP differs from all other endoscopic procedures for benign prostatic obstruction (BPO) because it removes the entire benign prostatic hyperplasia (BPH) component of the prostate (Figure 1). A variety of energy sources can be used to perform AEEP, for example high power holmium (100 watts or more), low power holmium (70 watts or less), thulium, greenlight and diode lasers, as well as monopolar and bipolar diathermy. This paper summarises the advantages of AEEP compared to the other surgical techniques for BPO (resection and vaporisation).

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

Cited by 18 publications

References 44 publications

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

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

Anatomical endoscopic enucleation of the prostate: The next gold standard? No! (or not yet!)

Anatomical endoscopic enucleation of the prostate: The next gold standard? Yes!

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