Monopolar enucleation versus transurethral resection of the prostate for small- and medium-sized (< 80 cc) benign prostate hyperplasia: a prospective analysis
- 36 Downloads
To assess efficacy and safety of monopolar enucleation of the prostate (MEP) and to compare it with the current treatment standard for medium-sized prostates, < 80 cc, transurethral resection of the prostate (TURP).
A prospective analysis patients undergoing a surgical procedure for their diagnosis of BPH (benign prostatic hyperplasia) (IPSS > 20, Qmax < 10; prostate volume < 80 cc) was performed. IPSS, Qmax were assessed preoperatively, at 6 and 12 months postoperatively. The complications were classified according to the modified Clavien–Dindo grading system.
A total of 134 patients were included in the study: 70 underwent MEP and 64 - TURP for BPH (mean prostate volumes were comparable with p = 0.163). The mean surgery time was 44 min in the TURP group and 48.2 min in the MEP group, (p = 0.026). Catheterization time for MEP was 1.7 and 3.2 days for TURP (p < 0.001). Hospital stay for MEP was 3.2 days vs. 4.8 days for TURP (p < 0.001). Both techniques shown comparable efficiency in benign prostatic obstruction relief with IPSS drop in MEP from 23.1 to 5.9 and in TURP group from 22.8 to 7.3, whereas Qmax increased from 8.2 to 20.5 after MEP and from 8.3 and 19.9 after TURP. Urinary incontinence rate after catheter removal in TURP group was 9.0% and 7.8% in MEP group, at 1 year follow-up, it was 1.4% and 3.1% in MEP and TURP, respectively (p = 0.466).
Our experience demonstrated that MEP is an effective and safe BPH treatment option combining the efficacy of endoscopic enucleation techniques and accessibility of conventional TURP.
KeywordsBPH Monopolar Endoscopic enucleation of the prostate EEP MEP TURP
DE—manuscript writing/editing; protocol/project development; LR—protocol/project development; MG—protocol/project development; SA—data collection and management; JI—data collection and management; MT—manuscript writing/editing; protocol/project development; data collection and analysis; EL—manuscript writing/editing; data collection and analysis; JMS—manuscript writing/editing; ZO—manuscript writing/editing; PG—protocol/project development.
Compliance with ethical standards
Conflict of interest
All authors state that they have no conflict of interest that might potentially bias they work.
The study was approved by the Sechenov University (Moscow, Russia) Institutional Review Board.
Informed consent was obtained from all individual participants included in the study.
- 1.Oelke M, Bachmann A, Descazeaud A, Emberton M, Gravas S, Michel MC, N’Dow J, Nordling J, de la Rosette JJ, European Association of U (2013) EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 64(1):118–140. https://doi.org/10.1016/j.eururo.2013.03.004 CrossRefGoogle Scholar
- 2.Peyronnet B, Pradere B, Brichart N, Bodin T, Bertrand P, Members of French Group of GreenLight U, Bruyere F (2014) Complications associated with photoselective vaporization of the prostate: categorization by a panel of green light users according to Clavien score and report of a single-center experience. Urology 84(3):657–664. https://doi.org/10.1016/j.urology.2014.05.028 CrossRefGoogle Scholar
- 4.Gravas S, Bach T, Bachmann A, Drake M, Gacci M, Gratzke C (2016) Management of non-neurogenic male lower urinary tract symptoms (LUTS), incl. Eur Assoc Urol, Benign Prostatic Obstruction (BPO) EAU Guidelines onGoogle Scholar
- 5.Li S, Zeng XT, Ruan XL, Weng H, Liu TZ, Wang X, Zhang C, Meng Z, Wang XH (2014) Holmium laser enucleation versus transurethral resection in patients with benign prostate hyperplasia: an updated systematic review with meta-analysis and trial sequential analysis. PLoS One 9(7):e101615. https://doi.org/10.1371/journal.pone.0101615 CrossRefGoogle Scholar
- 8.Cornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, McVary K, Novara G, Woo H, Madersbacher S (2015) A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol 67(6):1066–1096. https://doi.org/10.1016/j.eururo.2014.06.017 CrossRefGoogle Scholar
- 14.Ahyai SA, Gilling P, Kaplan SA, Kuntz RM, Madersbacher S, Montorsi F, Speakman MJ, Stief CG (2010) Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol 58(3):384–397. https://doi.org/10.1016/j.eururo.2010.06.005 CrossRefGoogle Scholar
- 17.Ajib K, Zgheib J, Salibi N, Zanaty M, Mansour M, Alenizi A, El-Hakim A (2018) Monopolar transurethral enucleo-resection of the prostate versus holmium laser enucleation of the prostate: a canadian novel experience. J Endourol 32(6):509–515. https://doi.org/10.1089/end.2017.0853 CrossRefGoogle Scholar
- 18.Enikeev DV, Glybochko PV, Okhunov Z, Alyaev YG, Rapoport LM, Tsarichenko D, Enikeev ME, Sorokin NI, Dymov AM, Taratkin MS (2018) Retrospective analysis of short-term outcomes after monopolar versus laser endoscopic enucleation of the prostate: a single center experience. J Endourol 32:417–423. https://doi.org/10.1089/end.2017.0898 CrossRefGoogle Scholar
- 19.Geavlete B, Stanescu F, Iacoboaie C, Geavlete P (2013) Bipolar plasma enucleation of the prostate vs open prostatectomy in large benign prostatic hyperplasia cases—a medium term, prospective, randomized comparison. BJU Int 111(5):793–803. https://doi.org/10.1111/j.1464-410X.2012.11730.x CrossRefGoogle Scholar
- 20.Enikeev D, Glybochko P, Rapoport L, Gahan J, Gazimiev M, Spivak L, Enikeev M, Taratkin M (2018) A randomized trial comparing the learning curve of 3 endoscopic enucleation techniques (HoLEP, ThuFLEP, and MEP) for BPH using mentoring approach-initial results. Urology 121:51–57. https://doi.org/10.1016/j.urology.2018.06.045 CrossRefGoogle Scholar
- 21.Choo MS, Lee HE, Bae J, Cho SY, Oh SJ (2014) Transurethral surgical anatomy of the arterial bleeder in the enucleated capsular plane of enlarged prostates during holmium laser enucleation of the prostate. Int Neurourol J 18(3):138–144. https://doi.org/10.5213/inj.2014.18.3.138 CrossRefGoogle Scholar