REVIEW   Free access

Minerva Urologica e Nefrologica 2020 June;72(3):292-312

DOI: 10.23736/S0393-2249.20.03706-6

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

En-bloc endoscopic enucleation of the prostate: a systematic review of the literature

Agostino TUCCIO ¹ ✉, Francesco SESSA ^{1, 2}, Riccardo CAMPI ^{1, 2}, Antonio A. GROSSO ¹, Lorenzo VIOLA ¹, Gianluca MUTO ¹, Cesare SCOFFONE ³, Cecilia M. CRACCO ³, Fernando GÓMEZ-SANCHA ⁴, Vincent MISRAI ⁵, Giovanni MUTO ⁶, Andrea MARI ¹, Fabrizio DI MAIDA ¹, Riccardo TELLINI ¹, Felipe FIGUEIREDO ⁷, Marco CARINI ^{1, 2}, Rino ORITI ⁸, Daniele AMPARORE ⁹, Cristian FIORI ⁹, Francesco PORPIGLIA ⁹, Andrea MINERVINI ^{1, 2}

¹ Department of Urology, Careggi Hospital, University of Florence, Florence, Italy; ² Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; ³ Department of Urology, Cottolengo Hospital, Turin, Italy; ⁴ Department of Urology, ICUA-Clinica CEMTRO, Madrid, Spain; ⁵ Department of Urology, Clinique Pasteur, Toulouse, France; ⁶ Department of Urology, Humanitas Gradenigo University, Turin, Italy; ⁷ Department of Urology, Pompéia Hospital, Caxias do Sul, Brazil; ⁸ Department of Urology, Ulivella e Glicini Clinic, Florence, Italy; ⁹ Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy

INTRODUCTION: Transurethral resection of the prostate (TURP) remains the gold standard for treatment of benign prostatic hyperplasia (BPH). Yet, the introduction of lasers for the treatment of LUTS due to BPO has dramatically changed the surgical landscape of benign prostatic obstruction (BPO) treatment. Recently, “en-bloc” techniques have shown to prove advantageous in terms of better visualization, more prompt identification of the surgical capsule and the correct plane to dissect. Herein we provide a comprehensive overview of available series of en-bloc enucleation of the prostate, focusing on surgical techniques, perioperative and functional outcomes.
EVIDENCE ACQUISITION: A systematic review of the literature was performed according to PRISMA recommendations and was conducted on surgical techniques and perioperative outcomes of minimally invasive en-bloc surgery for prostate adenoma detachment.
EVIDENCE SYNTHESIS: Overall, 16 studies with 2750 patients between 2003 and 2019 were included. Specific technical nuances have been described to maximize perioperative outcomes of en-bloc prostatic enucleation, including early apical release, horse-shape incisions, inverted U-shape tractions and low power. Overall, regardless of the energy employed, en-bloc prostatic enucleation achieved favorable outcomes including low risk of major complications and quality of life improvement. However, a great heterogeneity of study design, patients’ inclusion criteria, prostate volume and en-bloc surgical strategy was found.
CONCLUSIONS: En-bloc endoscopic enucleation of the prostate has been shown to be technically feasible and safe, with potential technical advantages over the classic three-lobe technique. Larger comparative studies are needed to evaluate the ultimate impact of the en-bloc approach on postoperative outcomes, in light of the surgeon’s learning curve.

KEY WORDS: Prostatic hyperplasia; Minimally-invasive surgical procedures; Lasers; Holmium; Thulium