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Published in: World Journal of Urology 9/2016

01-09-2016 | Invited Review

Transurethral enucleation of the prostate versus transvesical open prostatectomy for large benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials

Authors: Youcheng Lin, Xun Wu, Abai Xu, Rui Ren, Xueqiong Zhou, Yong Wen, Yong Zou, Mancheng Gong, Chunxiao Liu, Zexuan Su, Thomas R. W. Herrmann

Published in: World Journal of Urology | Issue 9/2016

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Abstract

Purpose

To evaluate the efficacy and safety of transurethral enucleation of the prostate (TUEP) versus transvesical open prostatectomy (OP) for the management of large benign prostatic hyperplasia (BPH).

Methods

Randomized controlled trials (RCTs) comparing TUEP and OP were identified from PubMed, Embase and Web of Science up to February 28, 2015. A meta-analysis was conducted with the STATA 12.0 software.

Results

Nine RCTs including 758 patients were enrolled in our meta-analysis. There were no significant differences between the two groups in the maximum urinary flow rate at 1, 3, 6 months, 1 and 2 years: postvoiding residual urinary volume, prostate-specific antigen, international prostate symptom score and quality of life score at 1, 3, 6 months and 1 year; or international index of erectile function at 3, 6 months and 1 year. Perioperative outcomes including hemoglobin level drop, catheter period, irrigation length and hospital stay favored TUEP, while operative time and resected prostate weight favored OP. There was significantly less blood transfusion with TUEP, but no significant differences were found in other complications such as recatheterization, urinary tract infection, reintervention for clots and bleeding control, incidence of pneumonia and infarction, transient incontinence, bladder neck contracture, urethral stricture and recurrent adenoma.

Conclusions

TUEP can be performed effectively and safely with functional outcomes and complications similar to OP for large BPH, whereas it has the advantages of a shorter catheter period, shorter hospital stays and less blood transfusion. These findings seem to support TUEP as the next-generation “gold standard” of surgery for large BPH.
Literature
1.
go back to reference 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. doi:10.1016/j.eururo.2014.06.017 CrossRefPubMed 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. doi:10.​1016/​j.​eururo.​2014.​06.​017 CrossRefPubMed
2.
go back to reference Gratzke C, Schlenker B, Seitz M, Karl A, Hermanek P, Lack N, Stief CG, Reich O (2007) Complications and early postoperative outcome after open prostatectomy in patients with benign prostatic enlargement: results of a prospective multicenter study. J Urol 177(4):1419–1422. doi:10.1016/j.juro.2006.11.062 CrossRefPubMed Gratzke C, Schlenker B, Seitz M, Karl A, Hermanek P, Lack N, Stief CG, Reich O (2007) Complications and early postoperative outcome after open prostatectomy in patients with benign prostatic enlargement: results of a prospective multicenter study. J Urol 177(4):1419–1422. doi:10.​1016/​j.​juro.​2006.​11.​062 CrossRefPubMed
5.
go back to reference McVary KT, Roehrborn CG, Avins AL, Barry MJ, Bruskewitz RC, Donnell RF, Foster HE Jr, Gonzalez CM, Kaplan SA, Penson DF, Ulchaker JC, Wei JT (2011) Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol 185(5):1793–1803. doi:10.1016/j.juro.2011.01.074 CrossRefPubMed McVary KT, Roehrborn CG, Avins AL, Barry MJ, Bruskewitz RC, Donnell RF, Foster HE Jr, Gonzalez CM, Kaplan SA, Penson DF, Ulchaker JC, Wei JT (2011) Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol 185(5):1793–1803. doi:10.​1016/​j.​juro.​2011.​01.​074 CrossRefPubMed
7.
go back to reference Alivizatos G, Skolarikos A, Chalikopoulos D, Papachristou C, Sopilidis O, Dellis A, Kastriotis I, Deliveliotis C (2008) Transurethral photoselective vaporization versus transvesical open enucleation for prostatic adenomas >80 ml: 12-mo results of a randomized prospective study. Eur Urol 54(2):427–437. doi:10.1016/j.eururo.2007.11.044 CrossRefPubMed Alivizatos G, Skolarikos A, Chalikopoulos D, Papachristou C, Sopilidis O, Dellis A, Kastriotis I, Deliveliotis C (2008) Transurethral photoselective vaporization versus transvesical open enucleation for prostatic adenomas >80 ml: 12-mo results of a randomized prospective study. Eur Urol 54(2):427–437. doi:10.​1016/​j.​eururo.​2007.​11.​044 CrossRefPubMed
11.
go back to reference Chen S, Zhu L, Cai J, Zheng Z, Ge R, Wu M, Deng Z, Zhou H, Yang S, Wu W, Liao L, Tan J (2014) Plasmakinetic enucleation of the prostate compared with open prostatectomy for prostates larger than 100 grams: a randomized noninferiority controlled trial with long-term results at 6 years. Eur Urol 66(2):284–291. doi:10.1016/j.eururo.2014.01.010 CrossRefPubMed Chen S, Zhu L, Cai J, Zheng Z, Ge R, Wu M, Deng Z, Zhou H, Yang S, Wu W, Liao L, Tan J (2014) Plasmakinetic enucleation of the prostate compared with open prostatectomy for prostates larger than 100 grams: a randomized noninferiority controlled trial with long-term results at 6 years. Eur Urol 66(2):284–291. doi:10.​1016/​j.​eururo.​2014.​01.​010 CrossRefPubMed
12.
go back to reference Iacono F, Prezioso D, Di Lauro G, Romeo G, Ruffo A, Illiano E, Amato B (2012) Efficacy and safety profile of a novel technique, ThuLEP (Thulium laser enucleation of the prostate) for the treatment of benign prostate hypertrophy. Our experience on 148 patients. BMC Surg 12(Suppl 1):S21. doi:10.1186/1471-2482-12-S1-S21 CrossRefPubMedPubMedCentral Iacono F, Prezioso D, Di Lauro G, Romeo G, Ruffo A, Illiano E, Amato B (2012) Efficacy and safety profile of a novel technique, ThuLEP (Thulium laser enucleation of the prostate) for the treatment of benign prostate hypertrophy. Our experience on 148 patients. BMC Surg 12(Suppl 1):S21. doi:10.​1186/​1471-2482-12-S1-S21 CrossRefPubMedPubMedCentral
13.
16.
go back to reference Skolarikos A, Papachristou C, Athanasiadis G, Chalikopoulos D, Deliveliotis C, Alivizatos G (2008) Eighteen-month results of a randomized prospective study comparing transurethral photoselective vaporization with transvesical open enucleation for prostatic adenomas greater than 80 cc. J Endourol/Endourol Soc 22(10):2333–2340. doi:10.1089/end.2008.9709 CrossRef Skolarikos A, Papachristou C, Athanasiadis G, Chalikopoulos D, Deliveliotis C, Alivizatos G (2008) Eighteen-month results of a randomized prospective study comparing transurethral photoselective vaporization with transvesical open enucleation for prostatic adenomas greater than 80 cc. J Endourol/Endourol Soc 22(10):2333–2340. doi:10.​1089/​end.​2008.​9709 CrossRef
17.
go back to reference Hiraoka Y (1983) A new method of prostatectomy, transurethral detachment and resection of benign prostatic hyperplasia. Nihon Ika Daigaku Zasshi 50(6):896–898CrossRefPubMed Hiraoka Y (1983) A new method of prostatectomy, transurethral detachment and resection of benign prostatic hyperplasia. Nihon Ika Daigaku Zasshi 50(6):896–898CrossRefPubMed
19.
go back to reference Fraundorfer MR, Gilling PJ (1998) Holmium:YAG laser enucleation of the prostate combined with mechanical morcellation: preliminary results. Eur Urol 33(1):69–72CrossRefPubMed Fraundorfer MR, Gilling PJ (1998) Holmium:YAG laser enucleation of the prostate combined with mechanical morcellation: preliminary results. Eur Urol 33(1):69–72CrossRefPubMed
20.
go back to reference Neill MG, Gilling PJ, Kennett KM, Frampton CM, Westenberg AM, Fraundorfer MR, Wilson LC (2006) Randomized trial comparing holmium laser enucleation of prostate with plasmakinetic enucleation of prostate for treatment of benign prostatic hyperplasia. Urology 68(5):1020–1024. doi:10.1016/j.urology.2006.06.021 CrossRefPubMed Neill MG, Gilling PJ, Kennett KM, Frampton CM, Westenberg AM, Fraundorfer MR, Wilson LC (2006) Randomized trial comparing holmium laser enucleation of prostate with plasmakinetic enucleation of prostate for treatment of benign prostatic hyperplasia. Urology 68(5):1020–1024. doi:10.​1016/​j.​urology.​2006.​06.​021 CrossRefPubMed
21.
go back to reference Geavlete B, Bulai C, Ene C, Checherita I, Geavlete P (2015) Bipolar vaporization, resection, and enucleation versus open prostatectomy: optimal treatment alternatives in large prostate cases? J Endourol/Endourol Soc 29(3):323–331. doi:10.1089/end.2014.0493 CrossRef Geavlete B, Bulai C, Ene C, Checherita I, Geavlete P (2015) Bipolar vaporization, resection, and enucleation versus open prostatectomy: optimal treatment alternatives in large prostate cases? J Endourol/Endourol Soc 29(3):323–331. doi:10.​1089/​end.​2014.​0493 CrossRef
22.
go back to reference Ou R, Deng X, Yang W, Wei X, Chen H, Xie K (2013) Transurethral enucleation and resection of the prostate vs transvesical prostatectomy for prostate volumes >80 mL: a prospective randomized study. BJU Int 112(2):239–245. doi:10.1111/bju.12181 CrossRefPubMed Ou R, Deng X, Yang W, Wei X, Chen H, Xie K (2013) Transurethral enucleation and resection of the prostate vs transvesical prostatectomy for prostate volumes >80 mL: a prospective randomized study. BJU Int 112(2):239–245. doi:10.​1111/​bju.​12181 CrossRefPubMed
23.
go back to reference Rao JM, Yang JR, Ren YX, He J, Ding P, Yang JH (2013) Plasmakinetic enucleation of the prostate versus transvesical open prostatectomy for benign prostatic hyperplasia >80 mL: 12-month follow-up results of a randomized clinical trial. Urology 82(1):176–181. doi:10.1016/j.urology.2013.02.032 CrossRefPubMed Rao JM, Yang JR, Ren YX, He J, Ding P, Yang JH (2013) Plasmakinetic enucleation of the prostate versus transvesical open prostatectomy for benign prostatic hyperplasia >80 mL: 12-month follow-up results of a randomized clinical trial. Urology 82(1):176–181. doi:10.​1016/​j.​urology.​2013.​02.​032 CrossRefPubMed
25.
go back to reference Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials 17(1):1–12CrossRefPubMed Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials 17(1):1–12CrossRefPubMed
26.
go back to reference Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral
28.
go back to reference Gilling PJ, Kennett KM, Fraundorfer MR (2000) Holmium laser enucleation of the prostate for glands larger than 100 g: an endourologic alternative to open prostatectomy. J Endourol/Endourol Soc 14(6):529–531CrossRef Gilling PJ, Kennett KM, Fraundorfer MR (2000) Holmium laser enucleation of the prostate for glands larger than 100 g: an endourologic alternative to open prostatectomy. J Endourol/Endourol Soc 14(6):529–531CrossRef
30.
go back to reference Kuntz RM, Lehrich K, Ahyai S (2004) Transurethral holmium laser enucleation of the prostate compared with transvesical open prostatectomy: 18-month follow-up of a randomized trial. J Endourol/Endourol Soc 18(2):189–191. doi:10.1089/089277904322959851 CrossRef Kuntz RM, Lehrich K, Ahyai S (2004) Transurethral holmium laser enucleation of the prostate compared with transvesical open prostatectomy: 18-month follow-up of a randomized trial. J Endourol/Endourol Soc 18(2):189–191. doi:10.​1089/​0892779043229598​51 CrossRef
31.
go back to reference Naspro R, Suardi N, Salonia A, Scattoni V, Guazzoni G, Colombo R, Cestari A, Briganti A, Mazzoccoli B, Rigatti P, Montorsi F (2006) Holmium laser enucleation of the prostate versus open prostatectomy for prostates >70 g: 24-month follow-up. Eur Urol 50(3):563–568. doi:10.1016/j.eururo.2006.04.003 CrossRefPubMed Naspro R, Suardi N, Salonia A, Scattoni V, Guazzoni G, Colombo R, Cestari A, Briganti A, Mazzoccoli B, Rigatti P, Montorsi F (2006) Holmium laser enucleation of the prostate versus open prostatectomy for prostates >70 g: 24-month follow-up. Eur Urol 50(3):563–568. doi:10.​1016/​j.​eururo.​2006.​04.​003 CrossRefPubMed
32.
go back to reference Salonia A, Suardi N, Naspro R, Mazzoccoli B, Zanni G, Gallina A, Bua L, Scattoni V, Rigatti P, Montorsi F (2006) Holmium laser enucleation versus open prostatectomy for benign prostatic hyperplasia: an inpatient cost analysis. Urology 68(2):302–306. doi:10.1016/j.urology.2006.02.007 CrossRefPubMed Salonia A, Suardi N, Naspro R, Mazzoccoli B, Zanni G, Gallina A, Bua L, Scattoni V, Rigatti P, Montorsi F (2006) Holmium laser enucleation versus open prostatectomy for benign prostatic hyperplasia: an inpatient cost analysis. Urology 68(2):302–306. doi:10.​1016/​j.​urology.​2006.​02.​007 CrossRefPubMed
33.
go back to reference Serretta V, Morgia G, Fondacaro L, Curto G, Lo bianco A, Pirritano D, Melloni D, Orestano F, Motta M, Pavone-Macaluso M, Members of the Sicilian-Calabrian Society of U (2002) Open prostatectomy for benign prostatic enlargement in southern Europe in the late 1990s: a contemporary series of 1800 interventions. Urology 60(4):623–627CrossRef Serretta V, Morgia G, Fondacaro L, Curto G, Lo bianco A, Pirritano D, Melloni D, Orestano F, Motta M, Pavone-Macaluso M, Members of the Sicilian-Calabrian Society of U (2002) Open prostatectomy for benign prostatic enlargement in southern Europe in the late 1990s: a contemporary series of 1800 interventions. Urology 60(4):623–627CrossRef
34.
go back to reference 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. doi:10.1016/j.eururo.2013.03.004 CrossRefPubMed 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. doi:10.​1016/​j.​eururo.​2013.​03.​004 CrossRefPubMed
35.
go back to reference Zheng SB, Liu CX, Xu YW (2005) Application of intracavitary retrograde dissection in transurethral vaporization resection of the prostate. Acad J First Med Coll PLA 25(6):734–735 Zheng SB, Liu CX, Xu YW (2005) Application of intracavitary retrograde dissection in transurethral vaporization resection of the prostate. Acad J First Med Coll PLA 25(6):734–735
36.
go back to reference Fayad AS, Sheikh MG, Zakaria T, Elfottoh HA, Alsergany R (2011) Holmium laser enucleation versus bipolar resection of the prostate: a prospective randomized study. Which to choose? J Endourol/Endourol Soc 25(8):1347–1352. doi:10.1089/end.2011.0059 CrossRef Fayad AS, Sheikh MG, Zakaria T, Elfottoh HA, Alsergany R (2011) Holmium laser enucleation versus bipolar resection of the prostate: a prospective randomized study. Which to choose? J Endourol/Endourol Soc 25(8):1347–1352. doi:10.​1089/​end.​2011.​0059 CrossRef
Metadata
Title
Transurethral enucleation of the prostate versus transvesical open prostatectomy for large benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials
Authors
Youcheng Lin
Xun Wu
Abai Xu
Rui Ren
Xueqiong Zhou
Yong Wen
Yong Zou
Mancheng Gong
Chunxiao Liu
Zexuan Su
Thomas R. W. Herrmann
Publication date
01-09-2016
Publisher
Springer Berlin Heidelberg
Published in
World Journal of Urology / Issue 9/2016
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-015-1735-9

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