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

Abstract

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

A Prospective, Randomized Study Comparing the Outcome After Thulium Laser Enucleation of the Prostate with Conventional Monopolar TURP for the Treatment of Symptomatic Benign Prostatic Hyperplasia

“…A meta-analysis published by Chen et al (2020) concluded that ThuLEP is a superior procedure to TURP and HoLEP. 14 A few other investigators have also concluded that ThuLEP is a superior enucleation technique to HoLEP. 8 , 15 , 16 …”

UPDATE – 2022 Canadian Urological Association guideline on male lower urinary tract symptoms/benign prostatic hyperplasia (MLUTS/BPH)

“…AEEP resulted in greater prostate tissue removal, reduced hemoglobin loss, shorter catheterization time, and shorter LOS. 63 Recent evidence supports the use of AEEP in patients with BPH on anticoagulant (AC) or antiplatelet (AP) therapy. [64][65][66] AEEP has demonstrated durable results with a low reoperation rate of 0-3.7% (attributed to adenoma regrowth) on long-term follow-up of up to 18 years.…”

Comparación <i>in vitro</i> de flujo de irrigación utilizando BipoLEP, HoLEP, y MiLEP

“…Está técnica ha demostrado menor tasa de sangrado, transfusión, tiempo con catéter y estadía hospitalaria que la cirugía abierta, pero con mayor tiempo operatorio 3 . De manera similar, al compararla con la resección transuretral de próstata ha demostrado mejores resultados funcionales, mayor volumen de tejido resecado, menor sangrado, menor tasa de transfusión y menor tiempo de hospitalización, pero con mayor tiempo operatorio 4 .…”