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Minerva Urology and Nephrology 2022 October;74(5):559-69

DOI: 10.23736/S2724-6051.21.04639-5


language: English

Enucleation vs. vaporization of benign prostatic hyperplasia: a head-to-head comparison of the various outcomes and complications. A systematic review and meta-analysis

Mark TARATKIN 1, Anastasia SHPIKINA 1, Andrey MOROZOV 1, Alexey NOVIKOV 2, Igor FOKIN 1, Vladislav PETOV 1, Thomas R. HERRMANN 3, 4, Vincent MISRAI 5, Lukas LUSUARDI 6, Jeremy Y.-C. TEOH 7, Jonathan MCFARLAND 8, 9, Vasiliy KOZLOV 10, Dmitry ENIKEEV 1

1 Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; 2 Moscow State Clinical Hospital named after Yudin, Moscow, Russia; 3 Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland; 4 Department of Urology, Hannover Medical School, Hannover, Germany; 5 Department of Urology, Clinique Pasteur, Toulouse, France; 6 Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria; 7 S.H. Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China; 8 Institute of Linguistics and Intercultural Communication, Sechenov University, Moscow, Russia; 9 Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain; 10 Department of Public Health and Healthcare, Sechenov University, Moscow, Russia

INTRODUCTION: Vaporization of the prostate (VP) and endoscopic enucleation of the prostate (EEP) are reliable and frequently used methods for BPO relief. Both surgeries utilize lasers and EAU recommends them in similar patient cohorts. Our objective was to compare intra- and perioperative results of patients who had undergone VP and EEP.
EVIDENCE ACQUISITION: A systematic literature search was performed in three databases (MEDLINE, Web of Science and Scopus). The detailed search strategy is available at Prospero, CRD42020204739. Primary outcomes were functional results (IPSS, QoL, PVR, Qmax), and secondary outcomes were intraoperative results, postoperative PSA and prostate volume, complications, and recurrence rate.
EVIDENCE SYNTHESIS: VP required less operative time compared to EEP, mean difference -5.51 (95% CI -7.52; -3.50). IPSS and Qmax for VP were worse after 12-month follow-up, mean difference 0.89 (95% CI 0.52; 1.27) and -3.7 (95% CI -4.56; -2.85), respectively, while QoL did not differ significantly. Postoperative PSA level was higher in the VP group, mean difference 2.28 (95% CI 2.00; 2.55). VP was associated with reduced Clavien-Dindo grade I (OR=4.16; 95% CI 2.96; 5.84) and grade II (OR=3.79; 95% CI 2.25; 6.39) complication rate, especially in terms of the percentage of blood transfusion and transient urinary incontinence. The rate of complications grade IIIa and higher was similar (3-6%). Reoperation rate was only estimated in one study and was significantly higher in the PVP group at 60 months of follow-up, 2.7% vs. 0%, P<0.05.
CONCLUSIONS: EEP and VP share the efficacy and safety in BPH management. Our meta-analysis shows comparable complication rate in Clavien-Dindo III, VP superiority in operation time, and EEP superiority in long-term functional outcomes and PSA reduction.

KEY WORDS: Systematic review; Prostatic hyperplasia; Prostate

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