Comparison of EEP and TURP long-term outcomes: systematic review and meta-analysis

Abstract

Objective: To compare long-term reoperation rate and functional outcomes between EEP (endoscopic enucleation of the prostate) and TURP (transurethral resection of the prostate).

Evidence acquisition: A systematic literature review of Medline, Scopus, and Web of Science was conducted with primary outcome assessed being reoperation rate and secondary outcomes after a long term (> 3 years) being functional outcomes or related values (prostate volume, PSA level, etc.).

Evidence synthesis: Five studies were found with long-term follow-up 4-7 years. EEP reoperation rate ranged from 0 to 1.27%, while from 1.7 to 17.6% for TURP. Meta-analysis showed significantly lower OR for EEP, 0.27 (95% CI 0.24-0.31), with notable homogeneity of the results, I² = 0%. Long-term Qmax and IPSS were significantly better for EEP. Q_max pooled mean difference was 1.79 (95% CI 1.72-1.86) ml/s with a high concordance among the studies, I² = 0%. IPSS mean difference -1.24 (95% CI - 1.28 to - 1.2) points, I² = 57% but QoL did not differ, with mean difference being 0.01 (95% CI - 0.02 to 0.04), I² = 0%. IIEF-5 score was also significantly better for EEP, mean difference 1.08 (95% CI 1.03-1.13), but heterogeneity was high, I² = 70%. PSA level and prostate volume were only reported in one study and favored EEP slightly yet statistically significant.

Conclusion: EEP had a significantly lower reoperation rate and better functional outcomes (Q_max and IPSS) at long term compared with TURP. It may also be beneficial in terms of IIEF-5, PVR, and PSA level.

Keywords: Benign prostate hyperplasia; Prostate enucleation; Systematic review; Transurethral prostate resection.