Endoscopic Enucleation versus Open Prostatectomy for Treating Large Benign Prostatic Hyperplasia: A Meta-Analysis of Randomized Controlled Trials

Li, Maoyin; Qiu, Jianguang; Hou, Qi; Wang, Dejuan; Huang, Wentao; Hu, Cheng; Li, Ké; Gao, Xin

doi:10.1371/journal.pone.0121265

Cited by 76 publications

(52 citation statements)

References 39 publications

(71 reference statements)

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“…No difference was seen in the rate of recatheterization, UTI, reintervention for clots and bleeding control, incidence of pneumonia and infarction, transient incontinence, bladder neck contracture, urethral stricture or recurrent adenoma. Li et al [10] came to the same conclusion analyzing seven RCTs.…”

Section: The Latest Update Of the Eau Guidelines On Management Of Nmentioning

confidence: 66%

Enucleation is enucleation is enucleation is enucleation

Herrmann

2016

World J Urol

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followed in 2004 [2], then later in the end of the 2000s all other transurethral laser-based enucleation techniques: Tm:YAG Vapoenucleation (ThuVEP) [3], transurethral anatomical enucleation with Tm:YAG Support (ThuLEP) [4], diode laser enucleation of the prostate (DiLEP) [5] and finally Lithium-Borate "Greenlight" enucleation of the prostate (GreenLEP) [6] appeared on the market to finally replace open prostatectomy (OP) and TURP. It took Thulium:YAG as the challenger to initiate a discussion about the impact of laser in transurethral enucleation. The surgical twins "ThuVEP" and "ThuLEP" demonstrated the whole spectrum of laser action in enucleating techniques. ThuVEP focuses on the favorable vaporization effect of continuous-wave lasers to perform a fast, effective and safe enucleation, whereas ThuLEP focuses on almost blunt mechanical enucleation using the laser only for dissection of adherences and mucosa. The latter on anatomy focusing approach was mimicked by other continuous-wave lasers (LBO/"Greenlight" and 980 nm diode laser) that had not been found suitable for enucleation at the initial point of the discussion [5,6].The most famous quotation from Gertrude Stein's poem Sacred Emily "Rose is a rose is a rose is a rose." is often interpreted as "things are what they are." When reviewing all meta-analyses and structured reviews of the past 3 years, the energy source seems to be secondary and a result of resources and personal preference of a skilled surgeon, today [7]. The time has come to move from sophistical marketing of a single energy source to the overarching principle of anatomical enucleation to focus all efforts to establish enucleation as the de facto standard treatment 32 years after Hiraoka [8] laid the cornerstone for all anatomical transurethral enucleation techniques of the prostate with his monopolar transurethral detachment prostatectomy technique (TUE). Abstract The latest update of the EAU Guidelines on Management of Non-Neurogenic Male Lower Urinary Tract Symptoms, incl. Benign Prostatic Obstruction in 2016 announced a novel acronym for transurethral Endoscopic Enucleation of the Prostate (EEP). This was inspired by a meta-analysis on randomized controlled trials on HolmiumLaser Enucleation of the Prostate (HolEP) and bipolar enucleation versus open simple prostatectomy. EEP codes for the common ground of both techniques: "anatomical enucleation." Although study quality with regard to the availability of long-term randomized controlled trials is at the moment mostly available for HoLEP, and bipolar enucleation, the existing data of all other enucleating techniques that have been demonstrated to perform anatomical enucleation as well should also been summarized under the same term. This editorial is a call for embracing this acronym of EEP for all anatomical enucleating techniques in order to serve for the transition from the age of TURP and open prostatectomy toward the age of EEP. Editorial,The great merit of holmium laser enucleation of the prostate (HoLEP) is to have laid out the re...

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Section: The Latest Update Of the Eau Guidelines On Management Of Nmentioning

confidence: 66%

Enucleation is enucleation is enucleation is enucleation

Herrmann

2016

World J Urol

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“…HoLEP has definitely come of age, and some even consider it the new gold standard . After its introduction 20 years ago, numerous RCTs and meta‐analyses confirmed the efficacy and safety of the procedure …”

Section: Discussionmentioning

confidence: 99%

“…Urologists need to know the true clinical benefits of each treatment option when counseling their patients. For larger prostates, randomized controlled trials (RCTs) and meta‐analyses confirmed the efficacy and safety of HoLEP compared to open prostatectomy . The LUTS improvements are at least equally effective, but a clear benefit was identified for perioperative parameters including the duration of hospital stay, shorter catheterization, and better hemostatic control.…”

Section: Introductionmentioning

confidence: 99%

A matched‐pair analysis of patients with medium‐sized prostates (50 cc) treated for male LUTS with HoLEP or TURP

Magistro

Westhofen

Stief

et al. 2019

LUTS

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Objectives: To evaluate perioperative parameters, early functional outcomes, and the safety profile in a matched-pair analysis of lower urinary tract symptom (LUTS) patients treated with holmium laser enucleation of the prostate (HoLEP) or transurethral resection of the prostate (TURP). Methods:We conducted a retrospective, matched-pair analysis of 2011 men treated for LUTS in our institution from 2013 to 2017. In the final analysis, 197 patients (HoLEP n = 97; TURP n = 98) were matched for prostate size (50 cc), age, and body mass index, and both cohorts were compared for demographic parameters, clinical outcomes, and adverse events according to the Clavien-Dindo classification.Results: The perioperative assessment revealed a significantly higher tissue retrieval percentage of 75.4% (interquartile range [IQR] 64-81.2) after HoLEP in comparison to 47.3% (IQR 40-54.7) after TURP (P <.001). A shorter surgery time was reported for TURP with a median time of 55.5 minutes (IQR 48-70.5), whereas the median time for HoLEP was 62 minutes (IQR 51-85) (P =.006). The median improvements in International Prostate Symptom Score (IPSS) were 11 points (IQR 5.5-17) and 7 points (IQR 3-14) for HoLEP and TURP, respectively (P =.007). Peak urinary flow rate (Q max ) increased more after HoLEP (12.0 mL/s; IQR 7-23) than after TURP (8.5 mL/s; IQR 5-18.25) (P =.028). With an overall incidence of adverse events of 6% (n = 6) compared to 16% (n = 16%), significantly fewer complications occurred after HoLEP than after treatment with TURP (P <.05). Conclusions:HoLEP is not only an attractive alternative for the enucleation of larger prostates, but it must be considered a size-independent technique with the potential to outdo the current reference method TURP. K E Y W O R D S benign prostatic hyperplasia, holmium laser enucleation of the prostate (HoLEP), lower urinary tract symptoms, transurethral resection of the prostate (TURP)

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“…Patients undergoing conventional TURP have shown a recent decreasing trend, as the efficacy of nucleation has been shown to be equal to or better than that method in several meta-analyses, [12][13][14] with treatment results reported to be equivalent as compared with open surgery for an enlarged prostate. 15 Additionally, several reports have shown the effectiveness of minimally invasive surgery techniques, such as enucleation and vaporization, which are becoming mainstream surgical methods for treatment of BPH. In Japan, the popularity of transurethral enucleation surgery with HoLEP or TUEB is surpassing that of TURP, with those newer techniques now used for most cases of prostatic enucleation.…”

Section: Discussionmentioning

confidence: 99%

Comparison of single‐ and multiple‐dose cefazolin as prophylaxis for transurethral enucleation of prostate: A multicenter, prospective, randomized controlled trial by the Japanese Research Group for Urinary Tract Infection

Togo¹,

Fukui²,

Ueda³

et al. 2020

Int J of Urology

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Objectives To compare the optimal administration period of antimicrobial prophylaxis in patients undergoing transurethral enucleation of the prostate for benign prostatic hyperplasia. Methods We carried out a randomized controlled trial to compare the differences in incidence of perioperative genitourinary tract infection between single and multiple (3 days) administrations of cefazolin for transurethral enucleation of the prostate in benign prostatic hyperplasia patients without pyuria or bacteriuria between January 2015 and December 2018. Results This multicenter randomized controlled trial included 203 patients who underwent a transurethral enucleation of the prostate procedure. All received antimicrobial prophylaxis, and were randomized into those who received single‐dose (n = 101) or multiple‐dose (n = 102) therapy. The rate of genitourinary tract infection after transurethral enucleation of the prostate for all patients was 1.5%, whereas that in the single‐dose group was 1.0% and in the multiple‐dose group was 2.0%, which were not significantly different (P = 1.00). Conclusions A single dose of antimicrobial prophylaxis as a prophylactic antibacterial drug is sufficient for patients undergoing transurethral enucleation of the prostate who do not have presurgical pyuria or bacteriuria.

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Endoscopic Enucleation versus Open Prostatectomy for Treating Large Benign Prostatic Hyperplasia: A Meta-Analysis of Randomized Controlled Trials

Cited by 76 publications

References 39 publications

Enucleation is enucleation is enucleation is enucleation

Enucleation is enucleation is enucleation is enucleation

A matched‐pair analysis of patients with medium‐sized prostates (50 cc) treated for male LUTS with HoLEP or TURP

Comparison of single‐ and multiple‐dose cefazolin as prophylaxis for transurethral enucleation of prostate: A multicenter, prospective, randomized controlled trial by the Japanese Research Group for Urinary Tract Infection

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