Davide Arcaniolo1, Celeste Manfredi1, Alessandro Veccia2,3, Thomas R W Herrmann4, Estevão Lima5, Vincenzo Mirone6, Ferdinando Fusco6, Cristian Fiori7, Alessandro Antonelli3, Jens Rassweiler8, Evangelos Liatsikos9, Francesco Porpiglia7, Marco De Sio1, Riccardo Autorino10,11. 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.
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 Qmax (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.
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 Qmax (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.
Entities:
Keywords:
BPO; Benign prostate obstruction; Bipolar transurethral resection of the prostate; Bladder outlet obstruction; EEP; Endoscopic enucleation of prostate; Systematic review; TURP; Transurethral enucleation
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