Minimally invasive procedures no longer just for small prostates

This study evaluated the effects and safety of transurethral enucleation of the prostate (TUEP) for the treatment of large benign prostatic hyperplasia (BPH).

Researchers concluded that TUEP is as safe and effective as the current standard-of-care surgery.

Although surgical treatments for BPH have become less invasive over the past years, very large prostates often still require open surgery. A minimally invasive procedure called transurethral enucleation of the prostate (TUEP) has recently been under the focus of investigation as a possible alternative.

TUEP allows for the destruction of prostate tissue using a small catheter inserted into the urethra (the penile opening). Compared to open surgery, this method is associated with less complications and faster recovery. However, the long-term effects and safety of TUEP are still under exam.

Nine separate randomized trials, including a combined total of 758 men, were included in this study. All men had large prostates (larger than 80-100 mL), and were candidates for open surgery. Outcomes of open surgery (a transvesical open prostatectomy procedure) were compared to those of TUEP.

During a follow-up of up to 2-years, there were no differences in treatment effectivity between the two procedures. Urinary symptoms, prostate-specific antigen levels, erectile function and quality of life, all received similar scores.  

While the amount of prostate tissue removed favored open surgery, complications around the time of the procedure were reduced with TUEP. Length of hospital stay was also reduced among men undergoing TUEP.

No differences were noted between the two procedures regarding complications such as urinary tract infection, temporary urinary incontinence or strictures (scaring and narrowing of the urethra).

This large meta-analysis (an analysis of pooled data from several trials) concluded that TUEP can be performed effectively and safely, even for the treatment of very large prostates.

This study did not compare the effects of TUEP to other minimally invasive procedures available for treating large prostates (such as bipolar TURP, laser enucleation or vaporization techniques).