Bipolar endoscopic enucleation versus bipolar transurethral resection of the prostate: an ESUT systematic review and cumulative analysis

Davide Arcaniolo; Celeste Manfredi; Alessandro Veccia; Thomas R W Herrmann; Estevão Lima; Vincenzo Mirone; Ferdinando Fusco; Cristian Fiori; Alessandro Antonelli; Jens Rassweiler; Evangelos Liatsikos; Francesco Porpiglia; Marco De Sio; Riccardo Autorino; EAU Section of Uro-Technology (ESUT) Research Group

doi:10.1007/s00345-019-02890-9

Bipolar endoscopic enucleation versus bipolar transurethral resection of the prostate: an ESUT systematic review and cumulative analysis

World J Urol. 2020 May;38(5):1177-1186. doi: 10.1007/s00345-019-02890-9. Epub 2019 Jul 25.

Authors

Davide Arcaniolo¹, Celeste Manfredi¹, Alessandro Veccia^{2

3}, Thomas R W Herrmann⁴, Estevão Lima⁵, Vincenzo Mirone⁶, Ferdinando Fusco⁶, Cristian Fiori⁷, Alessandro Antonelli³, Jens Rassweiler⁸, Evangelos Liatsikos⁹, Francesco Porpiglia⁷, Marco De Sio¹, Riccardo Autorino^{10

11}; EAU Section of Uro-Technology (ESUT) Research Group

Affiliations

¹ Urology Unit, Luigi Vanvitelli University, Naples, Italy.
² Division of Urology, Department of Surgery, VCU Health, VCU Medical Center, PO Box 980118, Richmond, VA, 23298-0118, USA.
³ Urology Unit and Department of Medical and Surgical Specialties, Radiological Science, and Public Health, ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy.
⁴ Department of Urology, Kantonsspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland.
⁵ Department of Urology, Braga Hospital, Braga, Portugal.
⁶ Department of Urology, Federico II University, Naples, Italy.
⁷ Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy.
⁸ Department of Urology, University of Heidelberg, SLK Kliniken, Heilbronn, Germany.
⁹ Department of Urology, University of Patras, Patras, Greece.
¹⁰ Urology Unit, Luigi Vanvitelli University, Naples, Italy. ricautor@gmail.com.
¹¹ Division of Urology, Department of Surgery, VCU Health, VCU Medical Center, PO Box 980118, Richmond, VA, 23298-0118, USA. ricautor@gmail.com.

PMID: 31346761
DOI: 10.1007/s00345-019-02890-9

Abstract

Purpose: To perform a cumulative analysis of the current evidence on the surgical and functional outcomes of bipolar endoscopic enucleation of the prostate (b-EEP) versus bipolar transurethral resection of the prostate (b-TURP).

Methods: A systematic review of the literature was performed on PubMed, Ovid^®, and Scopus^® according to Preferred Reporting Items for Systematic Review and Meta-analysis Statement (PRISMA Statement). The meta-analysis was conducted using the Review Manager 5.3 software. Parameters of interest were surgical and functional outcomes. Weighted mean difference, and odds ratio with 95% confidence interval were calculated for continuous and binary variables, respectively. Pooled estimates were calculated using the random-effect model.

Results: Fourteen comparative studies were included. No statistically significant difference in terms of overall baseline characteristics was found. b-EEP had higher amount of resected tissue (p < 0.0001), shorter catheter time (p = 0.006), lower Hb drop (p = 0.03), and shorter length of stay (p < 0.0001). Equally, overall post-operative complications were lower (p = 0.01) as well as short (p = 0.04), and long-term complication rate (p = 0.04). There was higher re-intervention rate in the b-TURP group (p = 0.02) whereas b-EEP group had smaller residual prostate volume (p = 0.03), and lower post-operative PSA values (p < 0.00001). At long term, b-EEP presented lower IPSS (p = 0.04), higher Q_max (p = 0.002), and lower PVR (p < 0.00001).

Conclusions: b-EEP is an effective and safe surgical treatment for BPO. This procedure might offer several advantages over standard b-TURP, including the resection of a larger amount of tissue within the same operative time, shorter hospitalization, lower risk of complications, and lower re-intervention rate. This was submitted to PROSPERO registry: CRD42019126748.

Keywords: BPO; Benign prostate obstruction; Bipolar transurethral resection of the prostate; Bladder outlet obstruction; EEP; Endoscopic enucleation of prostate; Systematic review; TURP; Transurethral enucleation.

Publication types

Systematic Review

MeSH terms

Electrosurgery*
Endoscopy / methods*
Europe
Humans
Male
Prostatectomy / methods*
Prostatic Hyperplasia / surgery*
Societies, Medical
Transurethral Resection of Prostate / methods
Urology