Surgical outcome of anatomical endoscopic enucleation of the prostate: A systemic review and meta-analysis

An increasing number of evidences demonstrate the safety and efficacy of endoscopic enucleation of the prostate (EEP) using various energy devices. We performed a systemic literature search for all relevant randomised controlled trials (RCTs) comparing any EEP technique with TURP or open prostatectomy (OP). A total of 21 RCTs with 2,957 patients were included; the majority were studies of holmium laser or bipolar diathermy. Compared to TURP, EEP resulted in greater improvement in IPSS (MD: −0.56, 95% CI: −0.90 to −0.23), PVR (MD: −2.24, 95% CI: −4.45 to −0.03) and Qmax (MD: −1.07, 95% CI: −1.53 to −0.61). EEP was associated with more prostate tissue removed (MD: −9.73, 95% CI: −15.71 to −3.75), less haemoglobin loss (MD: −0.47, 95% CI: −0.70 to −0.23), shorter catheterisation time (MD: −22.82, 95% CI: −30.11 to −15.52) and shorter length of hospitalisation (MD: −1.05, 95% CI: −1.33 to −0.78). Compared to OP, EEP resulted in equivalent functional outcomes. However, EEP was associated with less haemoglobin loss (MD: −1.17, 95% CI: −1.98 to −0.37), shorter catheterisation time (MD: −89.74, 95% CI: −112.60 to −66.88) and shorter length of hospitalisation (MD: −3.91, 95% CI: −4.63 to −3.60). The current evidence supports that EEP can be considered as a new standard of the surgical management for BPH.