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

Arcaniolo, Davide; Manfredi, Celeste; Veccia, Alessandro; Herrmann, Thomas; Lima, Estêvão; Mirone, Vincenzo; Fusco, Ferdinando; Fiori, Cristian; Antonelli, Alessandro; Rassweiler, Jens; Liatsikos, Evangelos; Porpiglia, Francesco; Sio, Marco De; Autorino, Riccardo

doi:10.1007/s00345-019-02890-9

Cited by 37 publications

(25 citation statements)

References 47 publications

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“…A recent systematic review included 14 studies comparing bipolar enucleation and resection. Similar to our present findings, significantly more haemoglobin loss, more resected tissue, catheter time, hospital stay and PSA reduction were reported after resection [20]. However, only five of the included studies were randomised controlled trials (RCTs).…”

Section: Discussionsupporting

confidence: 88%

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Randomised trial of bipolar resection vs holmium laser enucleation vs Greenlight laser vapo‐enucleation of the prostate for treatment of large benign prostate obstruction: 3‐years outcomes

et al. 2020

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Objective To compare transurethral resection in saline (TURIS), Greenlight laser vapo‐enucleation of the prostate (GL.PVEP), and holmium laser enucleation of the prostate (HoLEP), for controlling lower urinary tract symptoms secondary to large benign prostatic hyperplasia (BPH) and to assess non‐inferiority of 3‐year re‐treatment rates. Patients and Methods Eligible patients with BPH (prostate size 80–150 mL) were randomly assigned to one of the intervention groups. Non‐inferiority of re‐treatment rate was evaluated using a one‐sided test at 5% level of significance. Results At the time of analysis, 60 GL.PVEP, 60 HoLEP and 62 TURIS procedures were included. Perioperative parameters were comparable between groups; however, the operative time was longer in GL.PVEP vs HoLEP and TURIS, at a mean (SD) of 92 (32) vs 73 (30) and 83 (28) min (P = 0.005); and was less effective with a mean (SD) removal of 1.2 (0.4) vs 1.7 (0.7) and 1.4 (0.6) g/min (P < 0.001), respectively. Perioperative complications and need for auxiliary procedures were similar in the three groups; however, there was a significantly higher rate of capsular perforation in TURIS group (five, 8%) compared to one (1.6%) in the GL.PVEP group and none in the HoLEP group (P = 0.01). There was a significantly longer hospital stay, catheter‐time and higher rate of blood transfusion in the TURIS group. There was significant but comparable improvements in the International Prostate Symptom Score in three groups at different follow‐up points. At 3 years, re‐treatment for recurrent bladder outlet obstruction was required more after GL.PVEP and TURIS. More re‐do surgeries for recurrent obstructing prostate adenoma was reported after GL.PVEP (four, 6.7%) and TURIS (six, 9.7%) than for HoLEP (none) (P = 0.04). Conclusion The perioperative outcomes of GL.PVEP and HoLEP surpassed that of TURIS for the treatment of large prostates, but with a significantly prolonged operative time with GL.PVEP. The three techniques achieve good functional outcomes; however, 3‐year re‐treatment rates following TURIS and GL.PVEP were inferior to HoLEP.

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Section: Discussionsupporting

confidence: 88%

“…However, only five of the included studies were randomised controlled trials (RCTs). Furthermore, all included studies varied significantly in their endpoints and follow‐up durations, and none of them were powered to detect differences in long‐term re‐treatment [20].…”

Section: Discussionmentioning

confidence: 99%

Randomised trial of bipolar resection vs holmium laser enucleation vs Greenlight laser vapo‐enucleation of the prostate for treatment of large benign prostate obstruction: 3‐years outcomes

et al. 2020

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“…Since BipolEP was described by Neill et al. (2006) in 2006, its safety and efficacy has been supported by a substantial body of evidence (Arcaniolo et al., 2019). Our literature search identified three RCTs comparing the medium‐term functional outcomes of BipolEP with those of either TURP.…”

Section: Discussionmentioning

confidence: 99%

“…In a meta‐analysis by Arcaniolo et al. (2019) comparing only BipolEP with bipolar transurethral resection of prostate, BipolEP was associated with better functional outcomes and more favourable perioperative profiles. A meta‐analysis by Wroclawski et al.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Benign prostatic hyperplasia (BPH) is the most common aetiology of bladder outlet obstruction and lower urinary tract symptoms (LUTS) in men. While medical treatment is considered as the first-line treatment for male LUTS secondary to BPH, a substantial portion of men would require surgical intervention because of insufficient relief of LUTS with medications or having any absolute indication for surgery, such as recurrent or refractory urinary retention, recurrent urinary tract infections, bladder stones or diverticula, or dilatation of the upper urinary tract due to BPH, with or without renal insufficiency (Foster et al., 2019; Oelke et al., 2013). By removing the hyperplastic prostate tissue, the surgery can restore normal urine flow, relieve the LUTS, and avoid bladder dysfunction and damages to the upper urinary tract. Transurethral resection of prostate (TURP) and open prostatectomy (OP) have been traditionally considered as the gold standard of the surgical management for BPH (Foster et al., 2019; Oelke et al., 2013). TURP is currently the most common surgical modality for BPH with a medium to large prostate. It is generally effective in relieving the outlet obstruction. However, in TURP the prostate is resected in a piece-by-piece fashion, and bleeding may arise from any cutting. This usually requires repeated coagulation and is time-consuming. These facts significantly limit the efficiency of TURP and therefore usually prohibits a complete resection, especially in cases with a huge prostate. On the other hand, OP can simply achieve complete removal

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“…Eine Metaanalyse von Arcaniolo et al. [ 3 ] aus 2019 zeigt eine Überlegenheit der BipoLEP über die B‑TURP nicht nur hinsichtlich der Dauer von Katheterisierung ( p * = 0,006) und Krankenhausaufenthalt ( p * < 0.0001), sondern auch bei Hb-Verlust ( p * = 0,03), bei kurz- und langfristigen Komplikationen sowie bei verschiedenen Parametern zum funktionellen Outcome. Sicherlich sind weitere randomisiert kontrollierte Studien (RCT) notwendig, um die Sicherheit der BipoLEP auch bei Patienten unter AC/TAH zu prüfen, die ersten Ergebnisse sind jedoch vielversprechend und die BipoLEP könnte zukünftig eine Alternative zu den transurethralen laserbasierten Techniken darstellen.…”

Section: Endoskopisch Transurethrale Technikenunclassified

Die chirurgische Therapie der benignen Prostataobstruktion (BPO) beim antikoagulierten Patienten: eine Übersichtsarbeit über die Blutungsrisiken etablierter Techniken

Deininger

Herrmann

Schönburg

et al. 2020

Urologe

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Zusammenfassung Hintergrund Bei einer alternden Gesellschaft ist mit einer Zunahme der therapiebedürftigen benignen Prostataobstruktion (BPO) zu rechnen, auch der Anteil an Patienten mit kardiovaskulären Komorbiditäten unter Antikoagulation steigt an. Hier kann die operative Therapie der BPO problematisch sein. Die blutstillende Wirkung der Techniken ist von besonderer Bedeutung. Fragestellung Die folgende Übersichtsarbeit diskutiert die Datenlage zum Blutungsrisiko etablierter operativer Techniken und die Stellungnahme der EAU-Leitlinie „EAU Guidelines on Management of Non-Neurogenic Male Lower Urinary Tract symptoms (LUTS) incl. Benign Prostatic Obstruction (BPO)“ zu diesem Thema. Material und Methoden Es wurde eine Datenanalyse aus PubMed erstellt. Ergebnisse Die EAU-Leitlinie gibt der transurethralen Vaporisation der Prostata mittels Greenlight‑, Thulium- oder Diodenlaser und der Enukleation mittels Holmium- oder Thuliumlaser bei diesem Patientengut den Vorzug. Die bipolare ist der monopolaren transurethralen Resektion der Prostata (TURP) bei der Blutstillung überlegen. Die bipolare Enukleation der Prostata (BipoLEP) kann bei guter Hämostase zukünftig eine Alternative darstellen. Neuere minimal-invasive Techniken wie Urolift® (NeoTract, Pleasanton, USA), I‑TIND© (MediTate, Or-Akiva, Israel) und Rezūm™ (Boston Scientific, Boston, USA) zeigen ein geringes Blutungsrisiko, dies gilt auch für die Prostataarterienembolisation. Nicht geeignet erscheint die Aquaablation/AquaBeam® bei häufigen Nachblutungen. Die chirurgische Adenomektomie kann mit hoher Blutungsgefahr verbunden sein. Schlussfolgerung Transurethrale Laservaporisation und -enukleation der Prostata sind die Therapie der Wahl beim antikoagulierten Patienten, jedoch haben auch andere transurethrale Techniken, wie die BipoLEP, ein akzeptables Blutungsrisiko und können je nach lokalen Ressourcen eine Alternative darstellen. Neuere minimal-invasive Ansätze können zukünftig mehr an Bedeutung gewinnen.

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

Cited by 37 publications

References 47 publications

Randomised trial of bipolar resection vs holmium laser enucleation vs Greenlight laser vapo‐enucleation of the prostate for treatment of large benign prostate obstruction: 3‐years outcomes

Randomised trial of bipolar resection vs holmium laser enucleation vs Greenlight laser vapo‐enucleation of the prostate for treatment of large benign prostate obstruction: 3‐years outcomes

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

Die chirurgische Therapie der benignen Prostataobstruktion (BPO) beim antikoagulierten Patienten: eine Übersichtsarbeit über die Blutungsrisiken etablierter Techniken

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