title: The surgical treatment of a large prostatic adenoma: the laparoscopic approach--a systematic review.
abstract: OBJECTIVE
  To present a critical overview of the current literature on the role of laparoscopy for the surgical treatment of patients with large prostatic adenomas.
  
  
  METHODS
  A MedLine search for peer-reviewed studies on laparoscopic simple prostatectomy (LSP) was performed. The clinical studies that reported most of the following information were included: number of patients, prostate volume, operative time, blood loss, hospital stay, and the duration of catheterization, as well as functional outcomes and complications. Articles reporting a mean total prostate volume of <80 mL or a mean prostatic adenoma of <60 mL were excluded. The review was performed according to the PRISMA statement.
  
  
  RESULTS
  Fourteen articles on LSP were included in this systematic review with a total of 626 patients treated. Both transperitoneal and extraperitoneal approaches, as well as transvesical and transcapsular routes, have been described. Eleven articles were case-series and three were comparative retrospective nonrandomized studies. When compared with open simple prostatectomy (OP), LSP is associated with a less blood loss and a reduced irrigation requirement, a shorter postoperative catheterization period, and a shorter hospital stay, at the expense of an extended operative time. The limited number of patients treated, the selection biases due to the retrospective nature of several published articles on LSP, and the short follow-up periods are evident limits of the literature. I-square test demonstrated a high heterogeneity (93%) and consequently a high variability in the intervention effects in terms of maximum urinary flow rate (Qmax).
  
  
  CONCLUSIONS
  Even if LSP seems feasible and safe, there is still limited evidence regarding its long-term outcomes compared with OP.
authors.affiliation: UOC of Urology, Department of Surgery, University of Tor Vergata, Policlinico Casilino, Rome, Italy. tasospao2003@yahoo.com
authors.forename: Anastasios D
authors.initials: AD
authors.lastname: Asimakopoulos
authors.forename: Camille
authors.initials: C
authors.lastname: Mugnier
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Hoepffner
authors.forename: Enrico
authors.initials: E
authors.lastname: Spera
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Vespasiani
authors.forename: Richard
authors.initials: R
authors.lastname: Gaston
authors.forename: Gabriele
authors.initials: G
authors.lastname: Antonini
authors.forename: Thierry
authors.initials: T
authors.lastname: Piechaud
authors.forename: Roberto
authors.initials: R
authors.lastname: Miano
mesh_terms: D016063:Blood Loss, Surgical; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D019990:Perioperative Care; D011183:Postoperative Complications / Q000209:etiology; D011468:Prostatectomy / Q000009:adverse effects; D011470:Prostatic Hyperplasia / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome