Evaluating endoscopic procedures for patients with benign prostatic enlargment

This study reviewed trials that compared the safety and effectiveness of two different surgical procedures for patients with benign prostatic hyperplasia. The authors found that EEP and ENE are effective and safe for these patients.

In benign prostatic hyperplasia (BPH), the prostate is enlarged and presses on the bladder. This can cause urination problems that affect a patient's quality of life. BPH can be treated by surgically removing the prostate. Several surgical techniques are available to treat BPH.

Endoscopic enucleation (EEP) is a procedure that uses a thin tube with a cutting tool to cut and remove the prostate. EEP can be carried out with or without a laser. This technique removes more of the prostate and is less invasive than endoscopic non-enucleation (ENE). Whether EEP techniques are safer and more effective than ENE for patients with BPH is unclear.

This study analyzed the results of 35 studies. 3909 patients with BPH had EEP or ENE surgery. 327 patients had laser EEP or non-laser EEP. In most studies, patients were followed-up for up to 12 months.

At 12 to 18 months after surgery, patients who had EEP reported a lower symptom score (by 0.86 points) compared to patients who had ENE. No differences in quality of life were reported between the two groups. 

Patients who had EEP had increased urine flow right after surgery (by 1 mL/second). Urine flow continued to improve up to 1.77 mL/second compared to ENE. Patients who had EEP had  6 mL less urine left in the bladder after urination compared to ENE. The volume of remaining urine continued to decrease up to 9.57 mL compared to ENE.

During surgery, the EEP procedure was 12.46-minute longer than ENE. EEP was associated with a 62% less risk of needing a blood transfusion than ENE. However, EEP was associated with a 4.31 higher risk of bladder injury than ENE. After surgery, patients who had EEP had a significantly shorter hospital stay and required a catheter for less time than patients who had ENE.

There were no differences in urine flow or remaining urine volume in the bladder between laser EEP and non-laser EEP. However, during surgery, laser EEP resulted in more prostate tissue removal (1.83 grams) compared to non-laser EEP. Patients who had laser EEP lost 0.32 g/dL less blood than non-laser EEP. 

The authors found that EEP and ENE are both effective and safe for patients with BPH. However, EEP was associated with better outcomes during and after surgery.

The clinical trials analyzed here all had different inclusion criteria and different follow-up periods. The follow-up period for most studies was also short (up to 12 months). Long-term complications for these procedures were also not evaluated. More studies are needed to confirm these results.

Talk to your doctor about surgical options to improve your symptoms.