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

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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.

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Acknowledgments

The authors thank Richard Ashcroft for professionally reviewing the linguistic style of the manuscript.

Author contribution

Youcheng Lin, Xun Wu, Chunxiao Liu, Zexuan Su and Thomas RW Herrmann involved in protocol/project development; Youcheng Lin, Xun Wu, Abai Xu, Rui Ren and Mancheng Gong involved in data collection or management; Youcheng Lin, Xun Wu, Xueqiong Zhou, Yong Wen and Yong Zou involved in data analysis; and Youcheng Lin, Thomas RW Herrmann and Xun Wu involved in manuscript writing/editing.

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    Authors and Affiliations

    1. Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China

      Youcheng Lin, Abai Xu, Yong Wen, Yong Zou & Chunxiao Liu

    2. Department of Urology, Fujian Provincial Clinical College, Fujian Medical University, Fuzhou, China

      Youcheng Lin

    3. Department of Urology, The First Affiliated Hospital of Jinan University, No. 613, HuangPu Road (West), TianHe District, Guangzhou, 510630, China

      Xun Wu & Zexuan Su

    4. Department of Anatomy, School of Basic Medicine Science, Southern Medical University, Guangzhou, China

      Xun Wu & Zexuan Su

    5. Department of Urology and Andrology, Zhongshan City People’s Hospital of Sun Yat-sen University, Zhongshan, China

      Rui Ren & Mancheng Gong

    6. Department of Occupational Health and Occupational Medicine, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China

      Xueqiong Zhou

    7. Department of Urology and Urological Oncology, Hanover Medical School (MHH), Carl Neuberg Str. 1, 30625, Hanover, Germany

      Thomas R. W. Herrmann

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    Correspondence to Chunxiao Liu, Zexuan Su or Thomas R. W. Herrmann.

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    Conflict of interest

    Thomas R. W. Herrmann declares Karl Storz GmBH, Honoraria, Financial Support for attending Symposia, financial support for educational programs, Consultancy, Advisory, Royalties; Boston Scientific AG Honoraria, Financial support for attending Symposia, financial support for educational programs, Consultancy, Advisory Board; LISA Laser OHG AG Honoraria, Financial support for attending Symposia, financial support for educational programs; Ipsen Pharma Honoraria, Financial support for attending Symposia, Advisory Board. All other authors declare that they have no conflict of interest.

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    As the present study is a meta-analysis and structured review, this manuscript is in line with the Declaration of Helsinki.

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    Youcheng Lin and Xun Wu have contributed equally to this work.

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    Lin, Y., Wu, X., Xu, A. et al. Transurethral enucleation of the prostate versus transvesical open prostatectomy for large benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials. World J Urol 34, 1207–1219 (2016). https://doi.org/10.1007/s00345-015-1735-9

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    • DOI: https://doi.org/10.1007/s00345-015-1735-9

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