Laparoscopic simple prostatectomy vs bipolar plasma enucleation of the prostate in large benign prostatic hyperplasia: a two-center 3-year comparison

Abstract

Purpose To compare surgery outcomes and safety of button bipolar enucleation of the prostate vs laparoscopic simple prostatectomy in patients with large prostates (> 80 g) in a two-center cohort study. Methods All patients with lower urinary tract symptoms due to benign prostatic enlargement (Prostate volume > 80 cc) undergoing button bipolar enucleation of the prostate (BTUEP) or laparoscopic simple prostatectomy (LSP) in two centers were enrolled. Data on clinical history, physical examination, urinary symptoms, uroflowmetry and prostate volume were collected at 0, 1, 3 6, 12, 24 and 36 months. Early and long-term complications were recorded. Results Overall, 296 patients were enrolled. Out of them, 167/296 (56%) performed a LSP and 129/296 (44%) performed a BTUEP. In terms of efficacy both procedures showed durable results at three years with a reintervention rate of 8% in the LSP group and of 5% in the BTUEP group. In terms of safety, BTUEP and LSP presented similar safety profiles with a 9% of transfusion rate and no major complications. Conclusion LSP and BTUEP are safe and effective in treating large-volume adenomas with durable results at three years when performed in experienced centers.

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“…Our findings are broadly consistent with previously published literature. This suggests that even though there are some differences between the different surgical procedures, they appear to be equally effective for treatment of large BPH (19). Furthermore, it should be noted that we also observed that EEP had a superior 6-month PVR (only two studies involved), but this conclusion needs to be confirmed in high-quality randomized controlled trials (RCTs) with longer follow-up.…”

“…There was no difference in 3-month QoL (MD −0.13, 95% CI −0.79 to 0.52, p = 0.69). Furthermore, four studies (13,14,17,19) reported the postoperative PSA (Figure 3), and MISP had the same PSA as the EEP group during short-term follow-up (MD −0.19, 95% CI −0.55 to 0.18, p = 0.33). Of note, there was significant heterogeneity among studies (p < 0.10) for each metric.…”

“…We excluded 73 studies after reviewing abstracts and titles, and 6 articles after reading the full text. Finally, 8 studies involving 1,504 patients (492 MISP vs. 1,012 EEP) were included in the present meta-analysis (12)(13)(14)(15)(16)(17)(18)(19). These studies were published between 2015 and 2021.…”

“…Among them, one was a prospective study (16), six were retrospective studies (12-15, 18, 19), and one was a prospective randomized study (17). Four studies (12,13,18,19) focused on the comparison of LSP and EEP, three studies (14-16) focused on the comparison of RASP and EEP, and only one study (17) analyzed the comparison of LSP, RASP, and EEP. Additionally, since Fuschi et al (17) reported the comparison of two MISP technologies (LSP and RASP) with EEP, we divided their results into two parts and presented them as Fuschi 2020a (LSP vs. EEP) and Fuschi 2020b (RASP vs. EEP) during data analysis.…”

“…However, the MISP group had higher 6-month PVR (MD 14.39, 95% CI 11.06 to 17.72, p < 0.001) than the EEP group. Three trials (13,17,19) compared postoperative QOL in the MISP and EEP groups (Figure 3). There was no difference in 3-month QoL (MD −0.13, 95% CI −0.79 to 0.52, p = 0.69).…”