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A systematic review and meta-analysis of the safety and efficacy of endoscopic enucleation and non-enucleation procedures for benign prostatic enlargement

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Abstract

Introduction and objective

This study aims to evaluate safety and efficacy of different endoscopic enucleation of the prostate (EEP) techniques, by comparing laser (L-EEP) and non-laser (NL-EEP) procedures; and EEP versus other endoscopic non-enucleation (ENE) surgeries for benign prostatic enlargement (BPE).

Methods

A systematic literature review was performed for randomized clinical trials (RCT) that compared different endoscopic treatments for BPE, between 1982 and 2018. Two analyses were performed: (1) EEP versus ENE; and (2) L-EEP versus NL-EEP. Efficacy was assessed using perioperative data (removed tissue volume, operation time (OT), catheterization time, length of hospital stay); and functional outcomes [IPSS, IIEF-5, maximum flow rate (Qmax), postvoid residual volume (PVR), quality of life (QoL)]. Safety was assessed through complications (Hb and sodium decrease, transfusion rate). Meta-analyses were performed using RevMan® 5.3.

Results

Out of 35 RCTs (4066 patients), 31 (3909 patients) evaluated EEP versus ENE, and 4 (327 patients) evaluated L-EEP versus NL-EEP. EEP presented greater Qmax. Also, EEP presented less catheterization time, length of hospital stay, Hb decrease, transfusion rate. OT and bladder injury were greater with EEP. There were no significant differences between other items. L-EEP removed more tissue volume, with a smaller drop in serum Hb. There were no significant differences in other perioperative data, functional outcomes, complications.

Conclusions

EEP and ENE are effective and safe for treating BPE. Perioperative data favors EEP. Statistical differences, with questionable clinical significance in functional outcomes and complication rates were encountered. L-EEP provides greater tissue removal and smaller Hb decrease then NL-EEP, with similar functional profiles.

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Author notes

  1. Marcelo Langer Wroclawski and Saulo Borborema Teles contributed equally to the manuscript and are co-first authors.

Authors and Affiliations

  1. Hospital Israelita Albert Einstein, Rua Iguatemi 192, 4th Floor, São Paulo, SP, Brazil

    Marcelo Langer Wroclawski, Saulo Borborema Teles, Breno Santos Amaral, Paulo Priante Kayano, Jonathan Doyun Cha, Arie Carneiro, Wladimir Alfer Jr., Jose Monteiro Jr., Antonio Otero Gil & Gustavo Caserta Lemos

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  1. Marcelo Langer Wroclawski
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  2. Saulo Borborema Teles
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Contributions

Wroclawski ML protocol/project development, data collection or management, data analysis, manuscript writing/editing. Teles SB protocol/project development, data collection or management, data analysis, manuscript writing/editing. Amaral BS protocol/project development, data collection or management, data analysis, manuscript writing/editing. Kayano PP protocol/project development, data collection or management, data analysis, manuscript writing/editing. Cha JD data collection or management, manuscript writing/editing. Carneiro A protocol/project development, manuscript writing/editing. Alfer Jr W manuscript writing/editing. Monteiro Jr J manuscript writing/editing. Gil AO manuscript writing/editing. Lemos GC manuscript writing/editing.

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Correspondence to Marcelo Langer Wroclawski.

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Wroclawski, M.L., Teles, S.B., Amaral, B.S. et al. A systematic review and meta-analysis of the safety and efficacy of endoscopic enucleation and non-enucleation procedures for benign prostatic enlargement. World J Urol 38, 1663–1684 (2020). https://doi.org/10.1007/s00345-019-02968-4

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  • DOI: https://doi.org/10.1007/s00345-019-02968-4

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