The surgical strategies of benign prostatic hyperplasia with large size prostate: a systematic review and network meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Zhenghao , BAI Yunjin , ZHANG Xingming , WANG Jia ,  WEI Wuran

Department of Urology, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;

Corresponding?author：

WEI Wuran, Email: wzh2019kb@163.com

Keywords：

Surgical method; Benign prostatic hyperplasia; Safety; Efficacy; Network meta-analysis; ?

DOI：

10.7507/1672-2531.202001063

Video：

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Objectives The present network meta-analysis was conducted to evaluate the potential efficacy and safety of various surgical approaches in the treatment of benign prostatic hyperplasia with enlarged prostate.Methods PubMed, EMbase, The Cochrane Library, Clinicaltrials.gov and CNKI databases were electronically searched to identify eligible studies. Two reviewers independently screened literature, extracted data and evaluated risk of bias and the ADDIS 1.16.8 software was used to conduct meta-analysis.Results A total of 23 studies involving 2 849 patients with 5 approaches including open prostatectomy (OP), holmium laser enucleation of the prostate (HoLEP), plasmakinetic/bipolar plasmakinetic enucleation of the prostate (PK/BPEP), transurethral vaporization of the prostate (TUVP), and laparoscopic prostatectomy (LSP) were included. HoLEP, PK/BPEP and OP were superior to the other methods in improving the objective indicators and subjective feelings of patients during both short and medium-term follow-up. However, compared with OP, HoLEP and PK/BPEP were observed to result in a significantly lower hemoglobin level (MD=1.65, 95%CI 0.35 to 4.41; MD=2.62, 95%CI 0.64 to 2.90), longer postoperative irrigation time (MD=4.67, 95%CI 1.29 to 10.66; MD=2.67, 95%CI 1.32 to 6.63), as well as indwelling catheter after operation (MD=1.64, 95%CI 0.48 to 4.15; MD=2.52, 95%CI 0.60 to 3.78). In terms of short-term complications, PK/BPEP (RR=0.45, 95%CI 0.13 to 1.29) was found to be significantly lower than that of OP.Conclusions HoLEP and PK/BPEP can be probably used as a superior treatment option for large volume benign prostatic hyperplasia because of its better curative effect, higher safety and quick postoperative recovery.

Citation： WANG Zhenghao, BAI Yunjin, ZHANG Xingming, WANG Jia, WEI Wuran. The surgical strategies of benign prostatic hyperplasia with large size prostate: a systematic review and network meta-analysis. Chinese Journal of Evidence-Based Medicine, 2020, 20(12): 1413-1420. doi: 10.7507/1672-2531.202001063 Copy

1.	Griebling TL. Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence, and bladder outlet obstruction. BJU Int, 2011, 108(7): 1138-1139.
2.	Gratzke C, Bachmann A, Descazeaud A, et al. EAU guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol, 2015, 67(6): 1099-1109.
3.	Porpiglia F, Terrone C, Renard J, et al. Transcapsular adenomectomy(Millin): a comparative study, extraperitoneal laparoscopy versus open surgery. Eur Urol, 2006, 49(1): 120-126.
4.	Vincent MW, Gilling PJ. HoLEP has come of age. World J Urol, 2015, 33(4): 487-493.
5.	Geavlete B, Bulai C, Ene C, et al. Bipolar vaporization, resection, and enucleation versus open prostatectomy: optimal treatment alternatives in large prostate cases? J Endourol, 2015, 29(3): 323-331.
6.	Xie JB, Tan YA, Wang FL, et al. Extraperitoneal laparoscopic adenomectomy (Madigan) versus bipolar transurethral resection of the prostate for benign prostatic hyperplasia greater than 80?ml: complications and functional outcomes after 3-year follow-up. J Endourol, 2014, 28(3): 353-359.
7.	Suer E, Gokce I, Yaman O, et al. Open prostatectomy is still a valid option for large prostates: a high-volume, single-center experience. Urology, 2008, 72(1): 90-94.
8.	Higgins JPT, Thomas J, Chandler J, et al. Cochrane handbook for systematic reviews of interventions version 6.0 (updated July 2019). Cochrane, 2019. Available from: www.training.cochrane.org/handbook.
9.	Naspro R, Suardi N, Salonia A, et al. Holmium laser enucleation of the prostate versus open prostatectomy for prostates> 70g: 24-month follow-up. Eur Urol, 2006, 50(3): 563-568.
10.	Kuntz RM, Lehrich K. Transurethral holmium laser enucleation versus transvesical open enucleation for prostate adenoma greater than 100 gm: a randomized prospective trial of 120 patients. J Urol, 2002, 168(4 Pt 1): 1465-1469.
11.	Kuntz RM, Lehrich K, Ahyai S. Transurethral holmium laser enucleation of the prostate compared with transvesical open prostatectomy: 18-month follow-up of a randomized trial. J Endourol, 2004, 18(2): 189-191.
12.	張勇, 杜傳軍, 徐剛, 等. 經尿道鈥激光前列腺剜除術治療大體積良性前列腺增生. 中華男科學雜志, 2007, 13(12): 1091-1093.
13.	Rao JM, Yang JR, Ren YX, et al. Plasmakinetic enucleation of the prostate versus transvesical open prostatectomy for benign prostatic hyperplasia> 80mL: 12-month follow-up results of a randomized clinical trial. Urology, 2013, 82(1): 176-181.
14.	Kuntz RM, Lehrich K, Ahyai SA. Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol, 2008, 53(1): 160-166.
15.	Ou R, You M, Tang P, et al. A randomized trial of transvesical prostatectomy versus transurethral resection of the prostate for prostate greater than 80mL. Urology, 2010, 76(4): 958-961.
16.	Persu C, Georgescu D, Arabagiu I, et al. TURP for BPH. How large is too large? J Med Life, 2010, 3(4): 376-380.
17.	Salonia A, Suardi N, Naspro R, et al. Holmium laser enucleation versus open prostatectomy for benign prostatic hyperplasia: an inpatient cost analysis. Urology, 2006, 68(2): 302-306.
18.	Chen S, Zhu L, Cai J, et al. Plasmakinetic enucleation of the prostate compared with open prostatectomy for prostates larger than 100 grams: a randomized noninferiority controlled trial with long-term results at 6 years. Eur Urol, 2014, 66(2): 284-291.
19.	Alivizatos G, Skolarikos A, Chalikopoulos D, et al. Transurethral photoselective vaporization versus transvesical open enucleation for prostatic adenomas> 80ml: 12-mo results of a randomized prospective study. Eur Urol, 2008, 54(2): 427-437.
20.	Zhu L, Chen S, Yang S, et al. Electrosurgical enucleation versus bipolar transurethral resection for prostates larger than 70ml: a prospective, randomized trial with 5-year followup. J Urol, 2013, 189(4): 1427-1431.
21.	Horasanli K, Silay MS, Altay B, et al. Photoselective potassium titanyl phosphate (KTP) laser vaporization versus transurethral resection of the prostate for prostates larger than 70mL: a short-term prospective randomized trial. Urology, 2008, 71(2): 247-251.
22.	刁磊, 胡青林, 采有金, 等. HoLEP與TURP治療大體積前列腺增生臨床效果對比觀察. 山東醫藥, 2019, 59(26): 73-75.
23.	游猛, 吳杰英, 陳岳, 等. 恥骨上前列腺切除與經尿道前列腺電切治療大體積前列腺增生的比較. 中華腔鏡泌尿外科雜志(電子版), 2015, 9(3): 40-43.
24.	宋瑞彬, 陳素珍, 董山峰. 經尿道前列腺電切術與開放手術治療大體積前列腺增生的效果比較. 中國現代藥物應用, 2016, 10(13): 64-65.
25.	楊必林, 邱志勇. 經尿道前列腺電切剜除術治療大體積前列腺增生的療效. 深圳中西醫結合雜志, 2019, 29(9): 121-122.
26.	梁英學, 黃勇平, 蒙松, 等. 經尿道前列腺剜除電切術治療大體積前列腺增生患者的臨床療效和安全性觀察. 貴州醫藥, 2018, 42(4): 426-428.
27.	彭友彬. 經尿道前列腺剜除電切術與傳統經尿道前列腺電切術治療大體積前列腺增生效果比較. 中外醫學研究, 2019, 17(29): 45-47.
28.	祝睿, 陳林川, 鄧若平. 探討等離子前列腺剜除術治療大體積前列腺增生的臨床效果及安全性. 當代醫學, 2019, 25(5): 170-172.
29.	劉汀, 胡斌, 鄭典寶. 2 μm 激光前列腺剜除術與經尿道前列腺電切術治療大體積良性前列腺增生的對比研究. 臨床醫藥文獻電子雜志, 2017, 4(92): 18050-18052.
30.	盛明雄, 萬玲玲, 劉昌明. 經尿道選擇性綠激光汽化術與經尿道等離子電切術治療大體積前列腺增生的比較. 實用醫學雜志, 2016, 32(23): 3890-3893.
31.	Kathpalia R, Singh V, Sankhwar S. Bipolar plasma enucleation of the prostate vs open prostatectomy in large benign prostatic hyperplasia cases: a medium term, prospective, randomized comparison. BJU Int, 2013, 112(1): E3.
32.	Jepsen JV, Bruskewitz RC. Recent developments in the surgical management of benign prostatic hyperplasia. Urology, 1998, 51(4A Suppl): 23-31.

1. Griebling TL. Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence, and bladder outlet obstruction. BJU Int, 2011, 108(7): 1138-1139.
2. Gratzke C, Bachmann A, Descazeaud A, et al. EAU guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol, 2015, 67(6): 1099-1109.
3. Porpiglia F, Terrone C, Renard J, et al. Transcapsular adenomectomy(Millin): a comparative study, extraperitoneal laparoscopy versus open surgery. Eur Urol, 2006, 49(1): 120-126.
4. Vincent MW, Gilling PJ. HoLEP has come of age. World J Urol, 2015, 33(4): 487-493.
5. Geavlete B, Bulai C, Ene C, et al. Bipolar vaporization, resection, and enucleation versus open prostatectomy: optimal treatment alternatives in large prostate cases? J Endourol, 2015, 29(3): 323-331.
6. Xie JB, Tan YA, Wang FL, et al. Extraperitoneal laparoscopic adenomectomy (Madigan) versus bipolar transurethral resection of the prostate for benign prostatic hyperplasia greater than 80?ml: complications and functional outcomes after 3-year follow-up. J Endourol, 2014, 28(3): 353-359.
7. Suer E, Gokce I, Yaman O, et al. Open prostatectomy is still a valid option for large prostates: a high-volume, single-center experience. Urology, 2008, 72(1): 90-94.
8. Higgins JPT, Thomas J, Chandler J, et al. Cochrane handbook for systematic reviews of interventions version 6.0 (updated July 2019). Cochrane, 2019. Available from: www.training.cochrane.org/handbook.
9. Naspro R, Suardi N, Salonia A, et al. Holmium laser enucleation of the prostate versus open prostatectomy for prostates> 70g: 24-month follow-up. Eur Urol, 2006, 50(3): 563-568.
10. Kuntz RM, Lehrich K. Transurethral holmium laser enucleation versus transvesical open enucleation for prostate adenoma greater than 100 gm: a randomized prospective trial of 120 patients. J Urol, 2002, 168(4 Pt 1): 1465-1469.
11. Kuntz RM, Lehrich K, Ahyai S. Transurethral holmium laser enucleation of the prostate compared with transvesical open prostatectomy: 18-month follow-up of a randomized trial. J Endourol, 2004, 18(2): 189-191.
12. 張勇, 杜傳軍, 徐剛, 等. 經尿道鈥激光前列腺剜除術治療大體積良性前列腺增生. 中華男科學雜志, 2007, 13(12): 1091-1093.
13. Rao JM, Yang JR, Ren YX, et al. Plasmakinetic enucleation of the prostate versus transvesical open prostatectomy for benign prostatic hyperplasia> 80mL: 12-month follow-up results of a randomized clinical trial. Urology, 2013, 82(1): 176-181.
14. Kuntz RM, Lehrich K, Ahyai SA. Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol, 2008, 53(1): 160-166.
15. Ou R, You M, Tang P, et al. A randomized trial of transvesical prostatectomy versus transurethral resection of the prostate for prostate greater than 80mL. Urology, 2010, 76(4): 958-961.
16. Persu C, Georgescu D, Arabagiu I, et al. TURP for BPH. How large is too large? J Med Life, 2010, 3(4): 376-380.
17. Salonia A, Suardi N, Naspro R, et al. Holmium laser enucleation versus open prostatectomy for benign prostatic hyperplasia: an inpatient cost analysis. Urology, 2006, 68(2): 302-306.
18. Chen S, Zhu L, Cai J, et al. Plasmakinetic enucleation of the prostate compared with open prostatectomy for prostates larger than 100 grams: a randomized noninferiority controlled trial with long-term results at 6 years. Eur Urol, 2014, 66(2): 284-291.
19. Alivizatos G, Skolarikos A, Chalikopoulos D, et al. Transurethral photoselective vaporization versus transvesical open enucleation for prostatic adenomas> 80ml: 12-mo results of a randomized prospective study. Eur Urol, 2008, 54(2): 427-437.
20. Zhu L, Chen S, Yang S, et al. Electrosurgical enucleation versus bipolar transurethral resection for prostates larger than 70ml: a prospective, randomized trial with 5-year followup. J Urol, 2013, 189(4): 1427-1431.
21. Horasanli K, Silay MS, Altay B, et al. Photoselective potassium titanyl phosphate (KTP) laser vaporization versus transurethral resection of the prostate for prostates larger than 70mL: a short-term prospective randomized trial. Urology, 2008, 71(2): 247-251.
22. 刁磊, 胡青林, 采有金, 等. HoLEP與TURP治療大體積前列腺增生臨床效果對比觀察. 山東醫藥, 2019, 59(26): 73-75.
23. 游猛, 吳杰英, 陳岳, 等. 恥骨上前列腺切除與經尿道前列腺電切治療大體積前列腺增生的比較. 中華腔鏡泌尿外科雜志(電子版), 2015, 9(3): 40-43.
24. 宋瑞彬, 陳素珍, 董山峰. 經尿道前列腺電切術與開放手術治療大體積前列腺增生的效果比較. 中國現代藥物應用, 2016, 10(13): 64-65.
25. 楊必林, 邱志勇. 經尿道前列腺電切剜除術治療大體積前列腺增生的療效. 深圳中西醫結合雜志, 2019, 29(9): 121-122.
26. 梁英學, 黃勇平, 蒙松, 等. 經尿道前列腺剜除電切術治療大體積前列腺增生患者的臨床療效和安全性觀察. 貴州醫藥, 2018, 42(4): 426-428.
27. 彭友彬. 經尿道前列腺剜除電切術與傳統經尿道前列腺電切術治療大體積前列腺增生效果比較. 中外醫學研究, 2019, 17(29): 45-47.
28. 祝睿, 陳林川, 鄧若平. 探討等離子前列腺剜除術治療大體積前列腺增生的臨床效果及安全性. 當代醫學, 2019, 25(5): 170-172.
29. 劉汀, 胡斌, 鄭典寶. 2 μm 激光前列腺剜除術與經尿道前列腺電切術治療大體積良性前列腺增生的對比研究. 臨床醫藥文獻電子雜志, 2017, 4(92): 18050-18052.
30. 盛明雄, 萬玲玲, 劉昌明. 經尿道選擇性綠激光汽化術與經尿道等離子電切術治療大體積前列腺增生的比較. 實用醫學雜志, 2016, 32(23): 3890-3893.
31. Kathpalia R, Singh V, Sankhwar S. Bipolar plasma enucleation of the prostate vs open prostatectomy in large benign prostatic hyperplasia cases: a medium term, prospective, randomized comparison. BJU Int, 2013, 112(1): E3.
32. Jepsen JV, Bruskewitz RC. Recent developments in the surgical management of benign prostatic hyperplasia. Urology, 1998, 51(4A Suppl): 23-31.

Chinese Journal of Evidence-Based Medicine

The surgical strategies of benign prostatic hyperplasia with large size prostate: a systematic review and network meta-analysis

Abstract Full text Figures/Tables Video References Cited by

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