Presentation Authors: Saulo Teles*, Breno Amaral, Arie Carneiro, Paulo Kayano, Jonathan Cha, Wladimir Alfer Jr., Jose Monteiro Jr., Antonio Gil, Alan Barbosa, Alexandre Partezani, Danilo Lourenço, Gustavo Lemos, Marcelo Wroclawski, Sao Paulo, Brazil
Introduction: A great variety of surgical treatments are available for benign prostatic enlargement (BPE). This study aims to evaluate the safety and efficacy profile of different methods of endoscopic enucleation of the prostate (EEP), comparing laser (L-EEP) and non-laser (NL-EEP) techniques, and EEP versus other endoscopic non-enucleation (ENE) surgical techniques for BPE.
Methods: A systematic literature review was performed for all randomized clinical trials (RCTs) comparing different endoscopic surgical techniques for BPE treatment in PubMED, Embase and Cochrane, between 1982 and 2018. Two different analyses strategies were performed: 1) comparing all EEP versus ENE techniques options and 2) comparing L-EEP versus NL-EEP techniques. The efficacy was assessed by: a) perioperative data, including tissue volume removed, operation time (OT), catheterization time and hospital length of stay (LOS), and b) functional outcomes, which evaluate International Prostate Symptom Score (IPSS), IEFF-5, maximum flow rate (Qmax), postvoid residual volume (PVR) and quality of life (QoL). The technique safety was assessed by complications, Hb and sodium decrease and transfusion rate. Meta-analyses were performed using the RevManÂ® 5.3 software.
Results: Out of the 35 RCTs (4066 patients) comparing different techniques for BPE treatment, 32 studies (3819 patients) evaluated EEP versus ENE and 3 RCTs (247 patients) evaluated L-EEP versus NL-EEP methods. Comparing EEP vs ENE, the first was associated with greater Qmax after short and long-term follow-up (F/U). EEP was associated with shorter catheterization time, hospital LOS, and lesser Hb decrease and transfusion rate. OT and bladder injury were greater in the EEP group There were no significant differences between other evaluated items. Comparing EEP techniques, L-EEP group were associated with shorter OT and more tissue volume removed. There were no significant differences in others perioperative data, functional outcomes and complications comparisons between groups.
Conclusions: Endoscopic treatments for BPH has similar efficacy. EEP appear to be safe and is related with: lesser Hb decrease, lesser transfusion rate and increased bladder injury rate comparing to ENE. Comparing with NL-EEP, L-EEP provides a greater tissue removal and a shorter OT, with the same safety and functional profiles.