Presented by: Andrey Morozov MD, PhD
Institute for Urology and Reproductive Health, Sechenov University

Introduction

Endoscopic enucleation of the prostate (EEP) has been previously shown to result in a lower postoperative prostate volume as well as a decreased PSA level compared to transurethral resection of the prostate (TURP). However, patients’ outcomes with long term follow-up are still to be determined in order to assess durability of the effect. The study objectives were to compare long-term reoperation rate and functional outcomes between EEP and TURP.

Materials

We undertook a systematic literature review using three databases (Medline, Scopus, and Web of Science). The detailed search strategy is available at Prospero (CRD42021269261). According to PICO process (Patient, Intervention, Comparison, Outcomes) the scope of the review is as follows: P - patients with BPH; I – EEP; C – TURP; O – reoperation rate due to BPH regrowth, functional outcomes (Qmax, IPSS, QoL, IIEF-5, PVR), prostate volume, PSA level with follow- up longer than 3 years. The level of evidence for each study was estimated according to the Oxford Centre for Evidence-based Medicine scale. RoB2 tool was applied to assess risk of bias in randomized studies. The primary outcome was reoperation rate at > 3 years. Secondary outcomes included long-term functional outcomes or related values (prostate volume, PSA level, etc.).

Results

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The final sample consisted of 5 trials (4 prospective randomized controlled trials and one retrospective analysis) with long-term follow-up 4-7 years. EEP reoperation rate ranged from 0% to 1.27%, while – from 1.7% to 17.6% for TURP. Meta-analysis showed significantly lower OR for EEP, 0.27 (95% CI 0.24 – 0.31), with notable homogeneity of the results, I² = 0%. Long-term Q_max and IPSS were significantly better for EEP. Q_max pooled mean difference was 1.79 (95% CI 1.72 – 1.86) ml/s with a high concordance amongst the studies, I² = 0%. IPSS mean difference -1.24 (95% CI -1.28 – -1.2) points, I² = 57% but QoL did not differ, with mean difference being 0.01 (95% CI -0.02 – 0.04), I² = 0%. The residual urine volume measured by ultrasound was presented in 2 trials: while the first study showed significantly less PVR for EEP, the second one showed no difference (data was not suitable for meta-analysis). IIEF-5 score was also significantly better for EEP, mean difference 1.08 (95% CI 1.03 – 1.13), but heterogeneity was high, I² = 70%. PSA level and prostate volume were only reported in one study and favored EEP slightly yet statistically significantly.

Conclusion

EEP had a significantly lower reoperation rate and better functional outcomes (Qmax and IPSS) at long term compared with TURP. It may also be beneficial in terms of IIEF-5, PVR, and PSA level.

Funding

None

Lead Authors

Mark Taratkin, MD
Institute for Urology and Reproductive Health, Sechenov University

Co-Authors

Anastasia Shpikina, MD
Institute for Urology and Reproductive Health, Sechenov University

Yaron Ehrlich, MD
Division of Urology, Rabin Medical Center

Jonathan McFarland,
Faculty of Medicine, Universidad Autónoma Madrid

Vasiliy Kozlov,
Department of Public Health and Healthcare, Sechenov University

Harun Fajkovic, MD, PhD
Department of Urology, Medical University of Vienna

Juan Gomez Rivas, MD, PhD
Department of Urology, Clinico San Carlos University Hospital

Lukas Lusuardi, MD, PhD
Department of Urology, University Hospital Salzburg

Jeremy Yuen-Chun Teoh, MD
S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong

Thomas Herrmann, MD, PhD
Department of Urology, Hannover Medical School

Jack Baniel, MD, PhD
Division of Urology, Rabin Medical Center

Dmitry Enikeev, MD, PhD
Department of Urology, Medical University of Vienna