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Minerva Urologica e Nefrologica 2020 February;72(1):22-9

DOI: 10.23736/S0393-2249.19.03589-6

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

What is the standard surgical approach to large volume BPE? Systematic review of existing randomized clinical trials

Costantino LEONARDO 1, Riccardo LOMBARDO 1 , Luca CINDOLO 2, Alessandro ANTONELLI 3, Francesco GRECO 4, Angelo PORRECA 5, Domenico VENEZIANO 6, Antonio PASTORE 7, Orietta DALPIAZ 8, Carlo CERUTI 9, Paolo VERZE 10, Marco BORGHESI 11, Riccardo SCHIAVINA 11, Roberto FALABELLA 12, Andrea MINERVINI 13, on behalf of AGILE Group 

1 Deparment of Urology, Sapienza University, Rome, Italy; 2 Deparment of Urology, Villa Stuart Casa di Cura, Rome, Italy; 3 Deparment of Urology, Spedali Civili di Brescia, Brescia, Italy; 4 Deparment of Urology, Humanitas Gavazzeni, Bergamo, Italy; 5 Deparment of Urology, Policlinico Abano Terme, Abano Terme, Padua, Italy; 6 Department of Urology, Ospedali Riuniti di Reggio Calabria, Reggio Calabria, Italy; 7 Department of Urology, Presidio Ospedaliero Nord ASL Latina c/o ICOT Padiglione S. Maria Goretti, Latina, Italy; 8 Department of Urology, Medical University of Graz, Graz, Hungary; 9 Department of Urology, Clinic of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy; 10 Department of Urology, Federico II University of Naples, Naples, Italy; 11 Department of Urology, University of Bologna, Bologna, Italy; 12 Department of Urology, Azienda Ospedaliera Regionale di Potenza, Potenza, Italy; 13 Department of Urology, University of Florence, Florence, Italy



INTRODUCTION: In the past years several reviews have analysed different aspects of surgical techniques for patients with LUTS due to BPE however none of them have concentrated on large prostates treatment exclusively. Moreover, none of the reviews have focused on level 1 evidence which is essential to avoid bias and wrong conclusions. With this knowledge in mind, aim of the present review is to analyze the available randomized clinical trials assessing the management of patients with big prostates (>80 cc).
EVIDENCE ACQUISITION: A systematic review of the literature using the Medline, Scopus and Web of Science databases for relevant articles published until January 2019 was performed using both the Medical Subjects Heading and free test protocols. The search was conducted by combining the following terms: “Enucleation,” “Prostate,” “Benign Prostatic Hyperplasia,” “Holmium,” “laser,” “adenomectomy,” “Randomized clinical trial,” “Big” “large” “prostate,” “>80,” “≥80,” “transurethral resection of prostate,” “Thulium,” “Diode,” “laparoscopy,” “robotic,” “Plasmakinetic,” “green light” “532 nm” “YAG” “Lower Urinary tract symptoms”. Only randomized clinical trials were included in the analysis.
EVIDENCE SYNTHESIS: Overall 9 RCTs were retrieved with most of them reporting data at 1 year. The present trials compared enucleation, vaporization and open techniques between each other. In terms of perioperative outcomes all the techniques had similar operative times and resected weight however catheterization time and hospital stay were better in endoscopic techniques when compared to open surgery. In terms of functional outcomes (IPSS, QMAX and PVR) none of the techniques was proven superior to the other. When considering complications open procedures carried a higher risk of transfusions while no technique was proven superior to the others in terms of transient urge urinary incontinence, bladder neck contracture and reintervention. Only one trial was retrieved reporting five years data confirming the safety, efficacy and durability of simple prostatectomy SP and holmium laser enucleation of the prostate at five years.
CONCLUSIONS: According to our review no technique may be considered better than the other when treating large adenomas. Studies are still lacking to prove long term efficacy and future studies should clarify the role of prostatic artery embolization and minimally invasive simple prostatectomy in the management of prostates larger than 80 mL.


KEY WORDS: Prostatic hyperplasia; Lower urinary tract symptoms; Surgical procedures, operative

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