Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Clinical Research
  • Published:

Efficacy and safety of enucleation vs. resection of prostate for treatment of benign prostatic hyperplasia: a meta-analysis of randomized controlled trials

Prostate Cancer and Prostatic Diseases volume 22, pages 493–508 (2019)Cite this article

Subjects

Abstract

Purpose

The purpose of this study is to compare the efficacy and safety of transurethral enucleation and resection of prostate for treatment of benign prostatic hyperplasia (BPH).

Materials and methods

This meta-analysis was conducted through a systematic search before 1 September 2018. All included publications were randomized controlled trials (RCTs). Efficacy was evaluated based on International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), and quality of life (QoL). Perioperative data and complications postoperatively were also assessed. The quality assessment of included studies and results was performed by using the Cochrane System and GRADE (grading of recommendation assessment, development, and evaluation) System.

Results

Thirty-one publications involving 26 RCTs with 3283 patients were assessed in this review. The differences between enucleation and resection in IPSS, Qmax, and QoL at 1, 3, and 6 months postoperative were not significant. At 12 months postoperatively, IPSS and Qmax in the enucleation group were significantly better than those in the resection group. The results also suggested a benefit of enucleation over resection in hospital stay, hemoglobin loss, serum sodium decrease, blood transfusion rate, grade II, grade III complications, and early complications. However, resection exhibited a better operative time.

Conclusion

Compared with resection, enucleation showed better efficacy and safety postoperatively with less hematological changes and severe complications, except for longer operative time.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Reich O, Seitz M, Gratzke C, Schlenker B, Walther S, Stief C. [Benign prostatic hyperplasia (BPH): surgical therapy options]. Urol A. 2010;49:113–26.

    Article  CAS  Google Scholar 

  2. Reich O, Gratzke C, Bachmann A, Seitz M, Schlenker B, Hermanek P, et al. Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol. 2008;180:246–9.

    Article  PubMed  Google Scholar 

  3. Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)--incidence, management, and prevention. Eur Urol. 2006;50:969–79. Discussion 980

    Article  PubMed  Google Scholar 

  4. Ho HS, Yip SK, Lim KB, Fook S, Foo KT, Cheng CW. A prospective randomized study comparing monopolar and bipolar transurethral resection of prostate using transurethral resection in saline (TURIS) system. Eur Urol. 2007;52:517–22.

    Article  PubMed  Google Scholar 

  5. Gilling CC, Cass CB, Malcolm AR, Fraundorfer MR. Combination holmium and Nd:YAG laser ablation of the prostate: initial clinical experience. J Endourol. 1995;9:151–3.

    Article  CAS  PubMed  Google Scholar 

  6. Herrmann TR, Bach T, Imkamp F, Georgiou A, Burchardt M, Oelke M, et al. Thulium laser enucleation of the prostate (ThuLEP): transurethral anatomical prostatectomy with laser support. Introduction of a novel technique for the treatment of benign prostatic obstruction. World J Urol. 2010;28:45–51.

    Article  PubMed  Google Scholar 

  7. Kyriazis I, Swiniarski PP, Jutzi S, Wolters M, Netsch C, Burchardt M, et al. Transurethral anatomical enucleation of the prostate with Tm:YAG support (ThuLEP): review of the literature on a novel surgical approach in the management of benign prostatic enlargement. World J Urol. 2015;33:525–30.

    Article  PubMed  Google Scholar 

  8. Wendt-Nordahl G, Huckele S, Honeck P, Alken P, Knoll T, Michel MS, et al. 980-nm Diode laser: a novel laser technology for vaporization of the prostate. Eur Urol. 2007;52:1723–8.

    Article  PubMed  Google Scholar 

  9. Neill MG, Gilling PJ, Kennett KM, Frampton CM, Westenberg AM, Fraundorfer MR, et al. Randomized trial comparing holmium laser enucleation of prostate with plasmakinetic enucleation of prostate for treatment of benign prostatic hyperplasia. Urology. 2006;68:1020–4.

    Article  PubMed  Google Scholar 

  10. Rao JM, Yang JR, Ren YX, He J, Ding P, Yang JH. Plasmakinetic enucleation of the prostate versus transvesical open prostatectomy for benign prostatic hyperplasia>80 mL: 12-month follow-up results of a randomized clinical trial. Urology. 2013;82:176–81.

    Article  PubMed  Google Scholar 

  11. Balshem H, Helfand M, Schunemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64:401–6.

    Article  PubMed  Google Scholar 

  12. Ahyai SA, Chun FK, Lehrich K, Dahlem R, Zacharias MS, Fisch MM, et al. Transurethral holmium laser enucleation versus transurethral resection of the prostate and simple open prostatectomy--which procedure is faster? J Urol. 2012;187:1608–13.

    Article  PubMed  Google Scholar 

  13. Ahyai SA, Lehrich K, Kuntz RM. Holmium laser enucleation versus transurethral resection of the prostate: 3-year follow-up results of a randomized clinical trial. Eur Urol. 2007;52:1456–63.

    Article  PubMed  Google Scholar 

  14. Bozzini G, Seveso M, Melegari S, de Francesco O, Buffi NM, Guazzoni G, et al. Thulium laser enucleation (ThuLEP) versus transurethral resection of the prostate in saline (TURis): a randomized prospective trial to compare intra and early postoperative outcomes. Actas Urol Esp (Engl Ed). 2017;41:309–15.

    Article  CAS  Google Scholar 

  15. Briganti A, Naspro R, Gallina A, Salonia A, Vavassori I, Hurle R, et al. Impact on sexual function of holmium laser enucleation versus transurethral resection of the prostate: results of a prospective, 2-center, randomized trial. J Urol. 2006;175:1817–21.

    Article  PubMed  Google Scholar 

  16. Chang CH, Lin TP, Chang YH, Huang WJ, Lin AT, Chen KK. Vapoenucleation of the prostate using a high-power thulium laser: a one-year follow-up study. BMC Urol. 2015;15:40.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Chen YB, Chen Q, Wang Z, Peng YB, Ma LM, Zheng DC, et al. A prospective, randomized clinical trial comparing plasmakinetic resection of the prostate with holmium laser enucleation of the prostate based on a 2-year followup. J Urol. 2013;189:217–22.

    Article  PubMed  Google Scholar 

  18. Dragoslav Bašic JS, Potic Milan, Ignjatovic Ivan. Holmium laser enucleation versus transurethral resection of the prostate: a comparison of clinical results. Acta Chir Iugosl. 2013;60:15–20.

    Article  PubMed  Google Scholar 

  19. Fayad AS, Elsheikh MG, Zakaria T, Elfottoh HA, Alsergany R, Elshenoufy A, et al. Holmium laser enucleation of the prostate versus bipolar resection of the prostate: a prospective randomized study. “Pros and Cons”. Urology. 2015;86:1037–41.

    Article  PubMed  Google Scholar 

  20. Fayad AS, Sheikh MG, Zakaria T, Elfottoh HA, Alsergany R. Holmium laser enucleation versus bipolar resection of the prostate: a prospective randomized study. Which to choose? J Endourol. 2011;25:1347–52.

    Article  PubMed  Google Scholar 

  21. Gilling PJ, Wilson LC, King CJ, Westenberg AM, Frampton CM, Fraundorfer MR. Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years. BJU Int. 2012;109:408–11.

    Article  PubMed  Google Scholar 

  22. Gu M, Chen YB, Liu C, Wan X, Cai ZK, Chen Q, et al. Comparison of holmium laser enucleation and plasmakinetic resection of prostate: a randomized trial with 72-month follow-up. J Endourol. 2018;32:139–43.

    Article  PubMed  Google Scholar 

  23. Gupta N, Sivaramakrishna, Kumar R, Dogra PN, Seth A. Comparison of standard transurethral resection, transurethral vapour resection and holmium laser enucleation of the prostate for managing benign prostatic hyperplasia of > 40 g. BJU Int. 2006;97:85–9.

    Article  PubMed  Google Scholar 

  24. Hamouda A, Morsi G, Habib E, Hamouda H, Emam AB, Etafy M. A comparative study between holmium laser enucleation of the prostate and transurethral resection of the prostate: 12-month follow-up. J Clin Urol. 2016;7:99–104.

    Article  Google Scholar 

  25. Jhanwar A, Sinha RJ, Bansal A, Prakash G, Singh K, Singh V. Outcomes of transurethral resection and holmium laser enucleation in more than 60 g of prostate: a prospective randomized study. Urol Ann. 2017;9:45–50.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kuntz RM, Ahyai S, Lehrich K, Fayad A. Transurethral holmium laser enucleation of the prostate versus transurethral electrocautery resection of the prostate: a randomized prospective trial in 200 patients. J Urol. 2004;172:1012–6.

    Article  PubMed  Google Scholar 

  27. Li K, Wang D, Hu C, Mao Y, Li M, Si-Tu J, et al. A novel modification of transurethral enucleation and resection of the prostate in patients with prostate glands larger than 80 mL: surgical procedures and clinical outcomes. Urology. 2018;113:153–9.

    Article  PubMed  Google Scholar 

  28. Luo YH, Shen JH, Guan RY, Li H, Wang J. Plasmakinetic enucleation of the prostate vs plasmakinetic resection of the prostate for benign prostatic hyperplasia: comparison of outcomes according to prostate size in 310 patients. Urology. 2014;84:904–10.

    Article  PubMed  Google Scholar 

  29. A.Eltabey M, Sherif H, A.Hussein A. Holmium laser enucleation versus transurethral resection of the prostate. Can J Urol. 2010;17:5447–52.

    Google Scholar 

  30. Mavuduru RM, Mandal AK, Singh SK, Acharya N, Agarwal M, Garg S, et al. Comparison of HoLEP and TURP in terms of efficacy in the early postoperative period and perioperative morbidity. Urol Int. 2009;82:130–5.

    Article  CAS  PubMed  Google Scholar 

  31. Montorsi F, Naspro R, Salonia A, Suardi N, Briganti A, Zanoni M, et al. Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center, prospective, randomized trial in patients with obstructive benign prostatic hyperplasia. J Urol. 2004;172:1926–9.

    Article  PubMed  Google Scholar 

  32. Świniarski Piotrpaweł, S S, Dudzic waldemar, kęsy Stanisław. Thulium laser enucleation of the prostate (TmLEP)vs. transurethral resection of the prostate (TURP):evaluation of early results. Cent Eur J Urol. 2012;65:130–4.

    Article  Google Scholar 

  33. Ran L, He W, Zhu X, Zhou Q, Gou X. Comparison of fluid absorption between transurethral enucleation and transurethral resection for benign prostate hyperplasia. Urol Int. 2013;91:26–30.

    Article  PubMed  Google Scholar 

  34. Sun N, Fu Y, Tian T, Gao J, Wang Y, Wang S, et al. Holmium laser enucleation of the prostate versus transurethral resection of the prostate: a randomized clinical trial. Int Urol Nephrol. 2014;46:1277–82.

    Article  PubMed  Google Scholar 

  35. Tan AH, Gilling PJ, Kennett KM, Frampton C, Westenberg AM, Fraundorfer MR. A randomized trial comparing holmium laser enucleation of the prostate with transurethral resection of the prostate for the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia in large glands (40 to 200 grams). J Urol. 2003;170:1270–4.

    Article  CAS  PubMed  Google Scholar 

  36. Wilson LC, Gilling PJ, Williams A, Kennett KM, Frampton CM, Westenberg AM, et al. A randomised trial comparing holmium laser enucleation versus transurethral resection in the treatment of prostates larger than 40 grams: results at 2 years. Eur Urol. 2006;50:569–73.

    Article  PubMed  Google Scholar 

  37. Yang SS, Hsieh CH, Lee YS, Chang SJ. Diode laser (980 nm) enucleation of the prostate: a promising alternative to transurethral resection of the prostate. Lasers Med Sci. 2013;28:353–60.

    Article  PubMed  Google Scholar 

  38. Yang Z, Liu T, Wang X. Comparison of thulium laser enucleation and plasmakinetic resection of the prostate in a randomized prospective trial with 5-year follow-up. Lasers Med Sci. 2016;31:1797–802.

    Article  PubMed  Google Scholar 

  39. Yang Z, Wang X, Liu T. Thulium laser enucleation versus plasmakinetic resection of the prostate: a randomized prospective trial with 18-month follow-up. Urology. 2013;81:396–400.

    Article  PubMed  Google Scholar 

  40. Zhang K, Sun D, Zhang H, Cao Q, Fu Q. Plasmakinetic vapor enucleation of the prostate with button electrode versus plasmakinetic resection of the prostate for benign prostatic enlargement>90 ml: perioperative and 3-month follow-up results of a prospective, randomized clinical trial. Urol Int. 2015;95:260–4.

    Article  PubMed  Google Scholar 

  41. Zhao Z, Zeng G, Zhong W, Mai Z, Zeng S, Tao X. A prospective, randomised trial comparing plasmakinetic enucleation to standard transurethral resection of the prostate for symptomatic benign prostatic hyperplasia: three-year follow-up results. Eur Urol. 2010;58:752–8.

    Article  PubMed  Google Scholar 

  42. Zhu L, Chen S, Yang S, Wu M, Ge R, Wu W, et al. Electrosurgical enucleation versus bipolar transurethral resection for prostates larger than 70 ml: a prospective, randomized trial with 5-year followup. J Urol. 2013;189:1427–31.

    Article  PubMed  Google Scholar 

  43. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.

    Article  PubMed  Google Scholar 

  44. Vuichoud C, Loughlin KR. Benign prostatic hyperplasia:epidemiology, economics and evaluation. Can J Urol. 2015;22(Suppl 1):1–6.

    PubMed  Google Scholar 

  45. Rasch A, Gruber S, Perleth M. Learning curve in laser treatment of benign prostatic syndrome: a systematic review. Z Evid Fortbild Qual Gesund. 2013;107:335–43.

    Article  Google Scholar 

  46. Shah HN, Mahajan AP, Sodha HS, Hegde S, Mohile PD, Bansal MB. Prospective evaluation of the learning curve for holmium laser enucleation of the prostate. J Urol. 2007;177:1468–74.

    Article  PubMed  Google Scholar 

  47. EL-HAKIM A, ELHILALI MM. Holmium laser enucleation of the prostate can be taught: the first learning experience. BJU Int. 2002;90:863–9.

    Article  CAS  PubMed  Google Scholar 

  48. Lourenco T, Armstrong N, N’Dow J, Nabi G, Deverill M, Pickard R, et al. Systematic review and economic modelling of effectiveness and cost utility of surgical treatments for men with benign prostatic enlargement. Health Technol Assess. 2008;12:iii, ix–x. 1-146, 169-515

    Article  Google Scholar 

  49. Mebust WK, Holtgrewe HL, Cockett, Peters ATK, Transurethral PC. prostatectomy: Immediate and postoperative complications. A cooperative study of 13 participating institutions evaluating 3,885 patients. J Urol. 1989;141:243–7.

    Article  CAS  PubMed  Google Scholar 

  50. Krambeck AE, Handa SE, Lingeman JE. Experience with more than 1,000 holmium laser prostate enucleations for benign prostatic hyperplasia. J Urol. 2010;183:1105–9.

    Article  PubMed  Google Scholar 

  51. Smith RD, Patel A. Transurethral resection of the prostate revisited and updated. Curr Opin Urol. 2011;21:36–41.

    Article  PubMed  Google Scholar 

  52. Liao N, Yu J. A study comparing plasmakinetic enucleation with bipolar plasmakinetic resection of the prostate for benign prostatic hyperplasia. J Endourol. 2012;26:884–8.

    Article  PubMed  Google Scholar 

  53. Lerner LB, Tyson MD, Mendoza PJ. Stress Incontinence during the learning curve of holmium laser enucleation of the prostate. J Endourol. 2010;24:1655–58.

    Article  PubMed  Google Scholar 

  54. Kuntz RM, Lehrich K. Transurethral holmium laser enucleation versus transvesical open enucleation for prostate adenoma greater than 100 gm.: a randomized prospective trial of 120 patients. J Urol. 2002;168:1465–9.

    Article  PubMed  Google Scholar 

  55. Leliefeld HHJ, Stoevelaar HJ, McDonnell J. Sexual function before and after various treatments for symptomatic benign prostatic hyperplasia. BJU Int. 2002;89:208–13.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

YZ thanks his girlfriend Yuxiao Zhao, from Wuhan University, for her excellent advises on manuscript revision.

Funding

This study was funded by the National Natural Science Foundation of China (Grant Number: 81702518) and National Natural Science Foundation of China (Grant Number: 81500636).

Author information

Author notes

  1. These authors contributed equally: Yucong Zhang, Penghui Yuan

Authors and Affiliations

  1. Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

    Yucong Zhang, Penghui Yuan, Xintao Gao, Chao Wei, Zhuo Liu, Rui Li, Shaogang Wang, Jihong Liu & Xiaming Liu

  2. Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

    Yucong Zhang, Penghui Yuan, Xintao Gao, Chao Wei, Zhuo Liu, Rui Li, Shaogang Wang, Jihong Liu & Xiaming Liu

  3. Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

    Delin Ma

Authors
  1. Yucong Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Penghui Yuan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Delin Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xintao Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chao Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zhuo Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rui Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shaogang Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jihong Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Xiaming Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: YZ and XL. Methodology: PY, XG, and CW. Formal analysis: ZL. Investigation: XG and CW. Writing: PY and YZ. Writing, review, editing, and revision: DM, YZ, and RL. Supervision: SW and JL.

Corresponding author

Correspondence to Xiaming Liu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, Y., Yuan, P., Ma, D. et al. Efficacy and safety of enucleation vs. resection of prostate for treatment of benign prostatic hyperplasia: a meta-analysis of randomized controlled trials. Prostate Cancer Prostatic Dis 22, 493–508 (2019). https://doi.org/10.1038/s41391-019-0135-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41391-019-0135-4

This article is cited by

Search

Advanced search

Quick links