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Outcomes of minimally invasive simple prostatectomy for benign prostatic hyperplasia: a systematic review and meta-analysis

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Abstract

Purpose

(1) To assess the outcomes of minimally invasive simple prostatectomy (MISP) for the treatment of symptomatic benign prostatic hyperplasia in men with large prostates and (2) to compare them with open simple prostatectomy (OSP).

Methods

A systematic review of outcomes of MISP for benign prostatic hyperplasia with meta-analysis was conducted. The article selection process was conducted according to the PRISMA guidelines.

Results

Twenty-seven observational studies with 764 patients were analyzed. The mean prostate volume was 113.5 ml (95 % CI 106–121). The mean increase in Qmax was 14.3 ml/s (95 % CI 13.1–15.6), and the mean improvement in IPSS was 17.2 (95 % CI 15.2–19.2). Mean duration of operation was 141 min (95 % CI 124–159), and the mean intraoperative blood loss was 284 ml (95 % CI 243–325). One hundred and four patients (13.6 %) developed a surgical complication. In comparative studies, length of hospital stay (WMD −1.6 days, p = 0.02), length of catheter use (WMD −1.3 days, p = 0.04) and estimated blood loss (WMD −187 ml, p = 0.015) were significantly lower in the MISP group, while the duration of operation was longer than in OSP (WMD 37.8 min, p < 0.0001). There were no differences in improvements in Qmax, IPSS and perioperative complications between both procedures. The small study sizes, publication bias, lack of systematic complication reporting and short follow-up are limitations.

Conclusions

MISP seems an effective and safe treatment option. It provides similar improvements in Qmax and IPSS as OSP. Despite taking longer, it results in less blood loss and shorter hospital stay. Prospective randomized studies comparing OSP, MISP and laser enucleation are needed to define the standard surgical treatment for large prostates.

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Acknowledgments

IL was supported by the development fund of the CHUV University Hospital.

Conflict of interest

The authors declare no conflict of interest.

Ethical standard

The manuscript does not contain original clinical studies.

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Authors and Affiliations

  1. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria

    Ilaria Lucca, Shahrokh F. Shariat, Sebastian L. Hofbauer & Tobias Klatte

  2. Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

    Ilaria Lucca

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  1. Ilaria Lucca
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  2. Shahrokh F. Shariat
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  4. Tobias Klatte
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Correspondence to Tobias Klatte.

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Lucca, I., Shariat, S.F., Hofbauer, S.L. et al. Outcomes of minimally invasive simple prostatectomy for benign prostatic hyperplasia: a systematic review and meta-analysis. World J Urol 33, 563–570 (2015). https://doi.org/10.1007/s00345-014-1324-3

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  • DOI: https://doi.org/10.1007/s00345-014-1324-3

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