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.	张勇, 杜传军, 徐刚, 等. 经尿道钬激光前列腺剜除术治疗大体积良性前列腺增生. 中华男科学杂志, 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与TURP治疗大体积前列腺增生临床效果对比观察. 山东医药, 2019, 59(26): 73-75.
23.	游猛, 吴杰英, 陈岳, 等. 耻骨上前列腺切除与经尿道前列腺电切治疗大体积前列腺增生的比较. 中华腔镜泌尿外科杂志(电子版), 2015, 9(3): 40-43.
24.	宋瑞彬, 陈素珍, 董山峰. 经尿道前列腺电切术与开放手术治疗大体积前列腺增生的效果比较. 中国现代药物应用, 2016, 10(13): 64-65.
25.	杨必林, 邱志勇. 经尿道前列腺电切剜除术治疗大体积前列腺增生的疗效. 深圳中西医结合杂志, 2019, 29(9): 121-122.
26.	梁英学, 黄勇平, 蒙松, 等. 经尿道前列腺剜除电切术治疗大体积前列腺增生患者的临床疗效和安全性观察. 贵州医药, 2018, 42(4): 426-428.
27.	彭友彬. 经尿道前列腺剜除电切术与传统经尿道前列腺电切术治疗大体积前列腺增生效果比较. 中外医学研究, 2019, 17(29): 45-47.
28.	祝睿, 陈林川, 邓若平. 探讨等离子前列腺剜除术治疗大体积前列腺增生的临床效果及安全性. 当代医学, 2019, 25(5): 170-172.
29.	刘汀, 胡斌, 郑典宝. 2 μm 激光前列腺剜除术与经尿道前列腺电切术治疗大体积良性前列腺增生的对比研究. 临床医药文献电子杂志, 2017, 4(92): 18050-18052.
30.	盛明雄, 万玲玲, 刘昌明. 经尿道选择性绿激光汽化术与经尿道等离子电切术治疗大体积前列腺增生的比较. 实用医学杂志, 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. 张勇, 杜传军, 徐刚, 等. 经尿道钬激光前列腺剜除术治疗大体积良性前列腺增生. 中华男科学杂志, 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与TURP治疗大体积前列腺增生临床效果对比观察. 山东医药, 2019, 59(26): 73-75.
23. 游猛, 吴杰英, 陈岳, 等. 耻骨上前列腺切除与经尿道前列腺电切治疗大体积前列腺增生的比较. 中华腔镜泌尿外科杂志(电子版), 2015, 9(3): 40-43.
24. 宋瑞彬, 陈素珍, 董山峰. 经尿道前列腺电切术与开放手术治疗大体积前列腺增生的效果比较. 中国现代药物应用, 2016, 10(13): 64-65.
25. 杨必林, 邱志勇. 经尿道前列腺电切剜除术治疗大体积前列腺增生的疗效. 深圳中西医结合杂志, 2019, 29(9): 121-122.
26. 梁英学, 黄勇平, 蒙松, 等. 经尿道前列腺剜除电切术治疗大体积前列腺增生患者的临床疗效和安全性观察. 贵州医药, 2018, 42(4): 426-428.
27. 彭友彬. 经尿道前列腺剜除电切术与传统经尿道前列腺电切术治疗大体积前列腺增生效果比较. 中外医学研究, 2019, 17(29): 45-47.
28. 祝睿, 陈林川, 邓若平. 探讨等离子前列腺剜除术治疗大体积前列腺增生的临床效果及安全性. 当代医学, 2019, 25(5): 170-172.
29. 刘汀, 胡斌, 郑典宝. 2 μm 激光前列腺剜除术与经尿道前列腺电切术治疗大体积良性前列腺增生的对比研究. 临床医药文献电子杂志, 2017, 4(92): 18050-18052.
30. 盛明雄, 万玲玲, 刘昌明. 经尿道选择性绿激光汽化术与经尿道等离子电切术治疗大体积前列腺增生的比较. 实用医学杂志, 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

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