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  • Review Article
  • Clinical
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Enucleation of the prostate as retreatment for recurrent or residual benign prostatic obstruction: a systematic review and a meta-analysis

Prostate Cancer and Prostatic Diseases volume 26, pages 693–701 (2023)Cite this article

Subjects

Abstract

Background

Anatomical endoscopic enucleation of the prostate (AEEP) is recommended for first line surgical treatment of benign prostatic obstruction (BPO) caused by moderate and large prostatic adenoma. However, its role in the retreatment setting after failed previous surgical treatment for BPO remains uncaptured. In this scope, we performed a systematic review and meta-analysis aiming to assess the safety and efficacy of AEEP in the retreatment setting.

Methods

We searched PubMed, Cochrane Library and Embase databases from inception to March 2022 for prospective or retrospective studies involving patients undergoing prostatic enucleation for recurrent or residual BPO after previous standard or minimally invasive surgical treatments for BPO. Based on data availability, we performed a meta-analysis comparing AEEP in patients with recurrent or residual BPO versus AEEP for primary BPO. PROSPERO: CRD42022308941).

Results

We included 15 studies in the systematic review and 10 in the meta-analysis (6553 patients, 841 with recurrent or residual BPO and 5712 with primary BPO). All included studies involved patients undergoing HoLEP or ThuLEP. In terms of Qmax, post-void residual, International Prostate Symptom Score, removed adenoma, operative time, duration of catheterization and hospital stay, as well as complications, HoLEP for recurrent or residual BPO was equally effective compared to HoLEP for primary BPO up to 1 year postoperatively. Importantly, the beneficial effect of HoLEP on the retreatment setting was observed after previous standard or minimally invasive surgical treatments for BPO. The overall strength of evidence for all outcomes was deemed very low.

Conclusions

HoLEP may be safely and effectively used in experienced hands for the surgical treatment of recurrent or residual BPO in patients with large or moderate prostates following previous open, endoscopic or minimally invasive surgical treatment for BPO.

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Fig. 1: Forest plot of studies exploring the effect of HoLEP on Qmax in patients with recurrent or residual BPO versus primary BPO at 3 months after surgery.
Fig. 2: Forest plot of studies exploring the effect of HoLEP on PVR in patients with recurrent or residual BPO versus primary BPO at 3 months after surgery.
Fig. 3: Forest plot of studies exploring the effect of HoLEP on IPSS in patients with recurrent or residual BPO versus primary BPO at 3 months after surgery.

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Authors and Affiliations

  1. Department of Urology, University Hospital, LMU Munich, Munich, Germany

    Nikolaos Pyrgidis, Gerald Bastian Schulz & Christian Stief

  2. 1st Department of Urology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Ioannis Mykoniatis & Petros Sountoulides

  3. Department of Urology, Paracelsus Medical University (PMU) Hospital, Salzburg, Austria

    Lukas Lusuardi

  4. 2nd Department of Urology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Ioannis Sokolakis

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Pyrgidis, N., Mykoniatis, I., Lusuardi, L. et al. Enucleation of the prostate as retreatment for recurrent or residual benign prostatic obstruction: a systematic review and a meta-analysis. Prostate Cancer Prostatic Dis 26, 693–701 (2023). https://doi.org/10.1038/s41391-023-00677-z

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