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Peri- and post-operative outcomes, complications, and functional results amongst different modifications of endoscopic enucleation of the prostate (EEP): a systematic review and meta-analysis

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Abstract

Purpose

To investigate and assess outcomes, complications, and functional results amongst different modifications of endoscopic enucleation of the prostate (EEP).

Methods

We conducted a systematic review and meta-analysis according to the PRISMA checklist. We searched the Medline, Cochrane, and Embase databases. We included only randomised-controlled trials (RCT) comparing modifications of EEPs and assessed the risk of bias (RoB).

Results

Seven RCTs were included in the study. Overall, 1266 patients were treated with Holmium laser enucleation of the prostate (HoLEP) and 80 patients with thulium laser vapo-enucleation of the prostate (ThuVEP). The operative time during pulse shape-modified HoLEP was shorter when compared to standard pulse HoLEP (MD 18.08 min, 95% CI 8.11–28.05 min, p = 0.0004). The decrease in haemoglobin was significantly lower for two-lobe HoLEP when compared to three-lobe HoLEP (MD 0.16 g/dl, 95% CI 0.22–0.1 g/dl, p < 0.00001). Virtual Basket (VB) HoLEP showed a smaller haemoglobin decrease when compared to standard pulse HoLEP (1.12 ± 1.78 vs. 2.54 ± 1.23 g/dl, p = 0.03). When directly comparing one- vs. two- vs. three-lobe HoLEP, surgical time (p < 0.001) and enucleation efficiency (p = 0.006) were significantly different and favouring one- and two-lobe HoLEP in the study with the largest patient population included. No significant differences for complications were observed; however, Clavien–Dindo IVa events were reported for two patients.

Conclusion

All variations of EEP improve symptoms and functional parameters with a low incidence of high-grade complications. One- and two-lobe approaches and pulse shape-modified HoLEP seem to be beneficial in terms of operative time and blood loss.

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Data availability

Not applicable due to review format.

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Author information

Author notes

  1. Important Gernot Ortner and Karl H Pang sharing first authorship with Gernot Ortner being listed first and being corresponding author.

  2. Chandra Shekar Biyani and Theodoros Tokas sharing senior authorship and Theodoros Tokas being listed last.

Authors and Affiliations

  1. Department of Urology and Andrology, General Hospital Hall I.T., Milser Straße 10, 6060, Hall in Tirol, Austria

    Gernot Ortner & Theodoros Tokas

  2. Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria

    Gernot Ortner, Thomas R. W. Herrmann & Theodoros Tokas

  3. Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK

    Karl H. Pang

  4. Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, ON, Canada

    Yuhong Yuan

  5. Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland

    Thomas R. W. Herrmann

  6. Pyrah Department of Urology, The Leeds Teaching Hospital NHS Trust, Leeds, UK

    Chandra Shekhar Biyani

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Contributions

GO and KHP had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. TT and CSB were involved in study concept and design, and supervision. GO, KHP, and CYY acquired the data. GO and KHP carried out analysis and interpretation, drafted the manuscript, and conducted the statistical analysis. GO, KHP, CYY, TRWH, CSB, and TT critically revised the manuscript and provided administrative, technical or material support. No funding was obtained.

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Correspondence to Gernot Ortner.

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Gernot Ortner certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (e.g. employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None.

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Ortner, G., Pang, K.H., Yuan, Y. et al. Peri- and post-operative outcomes, complications, and functional results amongst different modifications of endoscopic enucleation of the prostate (EEP): a systematic review and meta-analysis. World J Urol 41, 969–980 (2023). https://doi.org/10.1007/s00345-023-04308-z

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