title: Endoscopic enucleation versus open prostatectomy for treating large benign prostatic hyperplasia: a meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  To evaluate the overall efficacy and safety of endoscopic enucleation of the prostate (EP) vs open prostatectomy (OP) for large benign prostatic hyperplasia (BPH).
  
  
  METHODS
  We conducted an electronic search of PubMed/Medline, EMBASE, The Cochrane Library, and Web of Science to detect all relevant randomized controlled trials (RCTs) comparing EP with OP. A meta-analysis was performed using Review Manager 5.3.
  
  
  RESULTS
  Seven RCTs (735 patients) were included. At the 3-, 6- and 12-month follow-up, there were no significant differences in the International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), quality of life (QoL) score and post-void residual urine volume (PVR) between EP and OP. The International Index of Erectile Function (IIEF-5) was higher with EP (weighted mean difference [WMD]: 1.00, 95% confidence interval [CI]: 0.21 to 1.78, p=0.01) at the 12-month follow-up. The catheterization time (WMD: 3.80 d, 95%CI: -5.11 to -2.48, P<0.00001) and hospital stay (WMD: 4.93 d, 95%CI: -5.96 to -3.89, P<0.00001) were shorter with EP. The duration of operation was longer for EP compared with OP (WMD: 16.21 min, 95%CI: 3.72 to 28.70, P=0.01). The resected tissue weight (WMD: -9.63 g, 95%CI: -14.46 to -4.81, P<0.0001) and decrease in hemoglobin (WMD: -1.14 g/dL, 95%CI: -1.81 to -0.47, P=0.0008) were less with EP. EP was associated with fewer blood transfusions (risk ratio: 0.22, 95%CI: 0.10 to 0.47, P=0.0001). There were no significant differences between EP and OP when comparing other complications.
  
  
  CONCLUSIONS
  Although only a limited number of RCTs with relatively limited follow-up are available, EP is shown to have a similar postoperative profile and comparable safety to OP. By contrast, EP may have a more desirable perioperative profile. EP appears to be an effective and safe minimally invasive option for treating large prostates that requires only brief convalescence.
authors.affiliation: Department of Urology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
authors.forename: Maoyin
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Urology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
authors.forename: Jianguang
authors.initials: J
authors.lastname: Qiu
authors.affiliation: Department of Urology, Central Hospital of Longgang District, Shenzhen, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Hou
authors.affiliation: Department of Urology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
authors.forename: Dejuan
authors.initials: D
authors.lastname: Wang
authors.affiliation: Department of Urology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
authors.forename: Wentao
authors.initials: W
authors.lastname: Huang
authors.affiliation: Department of Urology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Hu
authors.affiliation: Department of Urology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Li
authors.affiliation: Department of Urology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Gao
mesh_terms: D006801:Humans; D008297:Male; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic
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