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Comparison of EEP and TURP long-term outcomes: systematic review and meta-analysis

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World Journal of Urology Aims and scope Submit manuscript

Abstract

Objective

To compare long-term reoperation rate and functional outcomes between EEP (endoscopic enucleation of the prostate) and TURP (transurethral resection of the prostate).

Evidence acquisition

A systematic literature review of Medline, Scopus, and Web of Science was conducted with primary outcome assessed being reoperation rate and secondary outcomes after a long term (> 3 years) being functional outcomes or related values (prostate volume, PSA level, etc.).

Evidence synthesis

Five studies were found 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 Qmax and IPSS were significantly better for EEP. Qmax pooled mean difference was 1.79 (95% CI 1.72–1.86) ml/s with a high concordance among the studies, I2 = 0%. IPSS mean difference −1.24 (95% CI − 1.28 to − 1.2) points, I2 = 57% but QoL did not differ, with mean difference being 0.01 (95% CI − 0.02 to 0.04), I2 = 0%. 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 significant.

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.

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Data availability

Data supporting this study are included within the article and/or supporting materials.

References

  1. Naspro R, Gomez Sancha F, Manica M, Meneghini A, Ahyai S, Aho T et al (2017) From “gold standard” resection to reproducible “future standard” endoscopic enucleation of the prostate: what we know about anatomical enucleation. Minerva Urol Nefrol 69(5):446–458

    PubMed  Google Scholar 

  2. Aho T, Armitage J, Kastner C (2020) Anatomical endoscopic enucleation of the prostate: the next gold standard? Yes! Andrologia 52(8):e13643

    Article  PubMed  Google Scholar 

  3. Elkoushy MA, Elhilali MM (2016) Management of benign prostatic hyperplasia larger than 100 ml: simple open enucleation versus transurethral laser prostatectomy. Curr Urol Rep 17(6):44

    Article  PubMed  Google Scholar 

  4. Enikeev D, Okhunov Z, Rapoport L, Taratkin M, Enikeev M, Snurnitsyna O et al (2019) Novel thulium fiber laser for enucleation of prostate: a retrospective comparison with open simple prostatectomy. J Endourol 33(1):16–21. https://doi.org/10.1089/end.2018.0791

    Article  PubMed  Google Scholar 

  5. Das AK, Han TM, Hardacker TJ (2020) Holmium laser enucleation of the prostate (HoLEP): size-independent gold standard for surgical management of benign prostatic hyperplasia. Can J Urol 27(S3):44–50

    PubMed  Google Scholar 

  6. Magistro G, Schott M, Keller P, Tamalunas A, Atzler M, Stief CG et al (2021) Enucleation vs resection: a matched-pair analysis of TURP, HoLEP and bipolar TUEP in medium-sized prostates. Urology 154:221–226

    Article  PubMed  Google Scholar 

  7. Cornu JN, Ahyai S, Bachmann A, De La Rosette J, Gilling P, Gratzke C et al (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 67:1066–1096

    Article  PubMed  Google Scholar 

  8. Zhang Y, Yuan P, Ma D, Gao X, Wei C, Liu Z et al (2019) Efficacy and safety of enucleation vs resection of prostate for treatment of benign prostatic hyperplasia: a meta-analysis of randomized controlled trials. Prostate Cancer Prostatic Dis 22(4):493–508

    Article  CAS  PubMed  Google Scholar 

  9. Tan A, Liao C, Mo Z, Cao Y (2007) Meta-analysis of holmium laser enucleation versus transurethral resection of the prostate for symptomatic prostatic obstruction. Br J Surg 94(10):1201–1208

    Article  CAS  PubMed  Google Scholar 

  10. Yin L, Teng J, Huang C-J, Zhang X, Xu D (2013) Holmium laser enucleation of the prostate versus transurethral resection of the prostate: a systematic review and meta-analysis of randomized controlled trials. J Endourol 27(5):604–611

    Article  PubMed  Google Scholar 

  11. Enikeev D, Misrai V, Rijo E, Sukhanov R, Chinenov D, Gazimiev M et al (2021) EAU, AUA and NICE guidelines on surgical and minimally invasive treatment of benign prostate hyperplasia: a critical appraisal of the guidelines using the AGREE-II tool. Urol Int 106:1–10

    Article  PubMed  Google Scholar 

  12. Kuntz RM (2011) Transurethral enucleation is superior to resection. Nat Rev Urol 8(1):14–15

    Article  PubMed  Google Scholar 

  13. Enikeev D, Taratkin M, Morozov A, Singla N, Gabdulina S, Tarasov A et al (2020) Long-term outcomes of holmium laser enucleation of the prostate: a 5-year single-center experience. J Endourol 34(10):1055–1063

    Article  PubMed  Google Scholar 

  14. Cho MC, Song WH, Park J, Cho SY, Jeong H, Oh S-J et al (2018) Long-term outcomes of laser prostatectomy for storage symptoms: comparison of serial 5-year followup data between high performance system photoselective vaporization and holmium laser enucleation of the prostate. J Urol 199(6):1591–1599

    Article  PubMed  Google Scholar 

  15. Phillips B, Ball C, Sackett D, Badenoch D, Straus S, Haynes B, Dawes M (2009) Levels of evidence: Oxford centre for evidence-based medicine. Centre for Evidence Based Medicine, Oxford

  16. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I et al (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366:l4898. https://doi.org/10.1136/bmj.l4898

    Article  PubMed  Google Scholar 

  17. Gilling PJ, Wilson LC, King CJ, Westenberg AM, Frampton CM, Fraundorfer MR (2012) Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years. BJU Int 109(3):408–411

    Article  PubMed  Google Scholar 

  18. Zhu L, Chen S, Yang S, Wu M, Ge R, Wu W et al (2013) Electrosurgical enucleation versus bipolar transurethral resection for prostates larger than 70 ml: a prospective, randomized trial with 5-year followup. J Urol 189(4):1427–1431

    Article  PubMed  Google Scholar 

  19. Yang Z, Liu T, Wang X (2016) Comparison of thulium laser enucleation and plasmakinetic resection of the prostate in a randomized prospective trial with 5-year follow-up. Lasers Med Sci 31(9):1797–1802

    Article  PubMed  Google Scholar 

  20. Gu M, Chen YB, Liu C, Wan X, Cai ZK, Chen Q et al (2018) Comparison of holmium laser enucleation and plasmakinetic resection of prostate: a randomized trial with 72-month follow-up. J Endourol 32(2):139–143

    Article  PubMed  Google Scholar 

  21. Kim A, Hak AJ, Choi WS, Paick SH, Kim HG, Park HK (2021) Comparison of long-term effect and complications between holmium laser enucleation and transurethral resection of prostate: nations-wide health insurance study. Urology 154:1–8

    Article  CAS  Google Scholar 

  22. Huang S-W, Tsai C-Y, Tseng C-S, Shih M-C, Yeh Y-C, Chien K-L et al (2019) Comparative efficacy and safety of new surgical treatments for benign prostatic hyperplasia: systematic review and network meta-analysis. BMJ 367:l5919

    Article  PubMed  PubMed Central  Google Scholar 

  23. Moyad MA (2002) The placebo effect and randomized trials: analysis of conventional medicine. Urol Clin N Am 29(1):125–133

    Article  Google Scholar 

  24. van Leeuwen JHS, Castro R, Busse M, Bemelmans BLH (2006) The placebo effect in the pharmacologic treatment of patients with lower urinary tract symptoms. Eur Urol 50(3):440–453

    Article  PubMed  Google Scholar 

  25. Stridh A, Pontén M, Arver S, Kirsch I, Abé C, Jensen KB (2020) Placebo responses among men with erectile dysfunction enrolled in phosphodiesterase 5 inhibitor trials. JAMA Netw Open 3(3):e201423

    Article  PubMed  PubMed Central  Google Scholar 

  26. Speakman MJ, Cornu J-N, Gacci M, Gratzke C, Mamoulakis C, Herrmann TRW et al (2019) What is the required certainty of evidence for the implementation of novel techniques for the treatment of benign prostatic obstruction? Eur Urol Focus 5(3):351–356

    Article  PubMed  Google Scholar 

  27. Bhat A, Blachman-Braun R, Herrmann TRW, Shah HN (2022) Are all procedures for benign prostatic hyperplasia created equal? A systematic review on post-procedural PSA dynamics and its correlation with relief of bladder outlet obstruction. World J Urol 40(4):889–905

    Article  PubMed  Google Scholar 

  28. Oh S-J, Shitara T (2020) Enucleation of the prostate: an anatomical perspective. Andrologia 52(8):e13744

    Article  PubMed  Google Scholar 

  29. Feng L, Zhang D, Tian Y, Song J (2016) Thulium laser enucleation versus plasmakinetic enucleation of the prostate: a randomized trial of a single center. J Endourol 30(6):665–670

    Article  PubMed  Google Scholar 

  30. Enikeev DV, Glybochko PV, Alyaev YG, Rapoport LM, Sorokin NI, Enikeev ME et al (2017) Laser enucleation of the prostate (HOLEP and THULEP): a comparative effectiveness analysis in treating recurrent prostatic hyperplasia. Urologiia 4:50–54

    Article  Google Scholar 

  31. Morozov A, Taratkin M, Kozlov V, Tarasov A, Bezrukov E, Enikeev M et al (2020) Retrospective assessment of endoscopic enucleation of prostate complications: a single-center experience of more than 1400 patients. J Endourol 34(2):192–197

    Article  PubMed  Google Scholar 

  32. Xiao KW, Zhou L, He Q, Gao XS, Chen G, Ma YC et al (2019) Enucleation of the prostate for benign prostatic hyperplasia thulium laser versus holmium laser: a systematic review and meta-analysis. Lasers Med Sci 34:815–826

    Article  PubMed  Google Scholar 

  33. Enikeev D, Morozov A, Taratkin M, Misrai V, Rijo E, Podoinitsin A et al (2021) Systematic review of the endoscopic enucleation of the prostate learning curve. World J Urol 39(7):2427–2438

    Article  PubMed  Google Scholar 

  34. Qian X, Liu H, Xu D, Xu L, Huang F, He W et al (2017) Functional outcomes and complications following B-TURP versus HoLEP for the treatment of benign prostatic hyperplasia: a review of the literature and Meta-analysis. Aging Male 20(3):184–191

    CAS  PubMed  Google Scholar 

  35. Liu C, Zheng S, Li H, Xu K (2010) Transurethral enucleation and resection of prostate in patients with benign prostatic hyperplasia by plasma kinetics. J Urol 184(6):2440–2445

    Article  PubMed  Google Scholar 

  36. Gilfrich C, May M, Fahlenbrach C, Günster C, Jeschke E, Popken G et al (2021) Surgical reintervention rates after invasive treatment for lower urinary tract symptoms due to benign prostatic syndrome: a comparative study of more than 43,000 patients with long-term followup. J Urol 205(3):855–863

    Article  PubMed  Google Scholar 

Download references

Funding

This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia

    Andrey Morozov, Mark Taratkin, Anastasia Shpikina, Alim Dymov & Dmitry Enikeev

  2. Division of Urology, Rabin Medical Center, Petach Tikva, Israel

    Yaron Ehrlich & Jack Baniel

  3. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Yaron Ehrlich & Jack Baniel

  4. Institute of Linguistics and Intercultural Communication, Sechenov University, Moscow, Russia

    Jonathan McFarland

  5. Faculty of Medicine, Universidad Autónoma Madrid, Madrid, Spain

    Jonathan McFarland

  6. Department of Public Health and Healthcare, Sechenov University, Moscow, Russia

    Vasiliy Kozlov

  7. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria

    Harun Fajkovic & Dmitry Enikeev

  8. Department of Urology, Medical University of Vienna, Währinger Gürtel 18–20, 1090, Vienna, Austria

    Harun Fajkovic & Dmitry Enikeev

  9. Department of Urology, Clinico San Carlos University Hospital, Madrid, Spain

    Juan Gomez Rivas

  10. Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria

    Lukas Lusuardi

  11. S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China

    Jeremy Yuen-Chun Teoh

  12. Department of Urology, Spital Thurgau AG, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland

    Thomas Herrmann

  13. Department of Urology, Hannover Medical School, Hannover, Germany

    Thomas Herrmann

Authors
  1. Andrey Morozov
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  2. Mark Taratkin
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  3. Anastasia Shpikina
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  4. Yaron Ehrlich
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  6. Alim Dymov
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  7. Vasiliy Kozlov
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  8. Harun Fajkovic
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  11. Jeremy Yuen-Chun Teoh
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  12. Thomas Herrmann
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  13. Jack Baniel
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  14. Dmitry Enikeev
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Contributions

AM: project development, data analysis, manuscript writing. MT: project development, data collection, manuscript writing. AS: data collection, manuscript writing. YE: manuscript editing. JMF: manuscript editing. AD: manuscript editing. VK: data analysis. HF: manuscript editing. JGR: manuscript editing. LL: manuscript editing. JYCT: manuscript editing. TH: project development, manuscript editing. JB: manuscript editing. DE: project development, data management, manuscript writing.

Corresponding author

Correspondence to Dmitry Enikeev.

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Morozov, A., Taratkin, M., Shpikina, A. et al. Comparison of EEP and TURP long-term outcomes: systematic review and meta-analysis. World J Urol 41, 3471–3483 (2023). https://doi.org/10.1007/s00345-023-04666-8

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  • DOI: https://doi.org/10.1007/s00345-023-04666-8

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