Laser enucleation of the prostate in men with very large glands ≥175 ml: A systematic review.

Background

Surgical treatment options for lower urinary tract symptoms can differ according to prostate size. There are few studies on the efficacy and safety of endoscopic enucleation of prostate (EEP) in patients with very large prostates focusing on laser as energy source. In this systematic review, we aimed to examine the efficacy and safety of laser-based EEP on prostate glands ≥150 ml.

Methods

A systematic search was conducted using Web of Science, PubMed-MEDLINE, Wiley Online Library and Cochrane Library databases with the following search terms solely or in combination: "large prostate", "laser enucleation", "laser prostatectomy"by combining PICO (population, intervention, comparison, and outcome) terms. Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were followed.

Results

We retrieved 6 studies included 375 patients with prostate sizes ≥175 ml treated with laser-based EEP for symptomatic benign prostatic obstruction. Three studies examined Holmium laser enucleation of prostate (HoLEP) outcomes with a prostate volume (PV) >200 ml, one evaluated HoLEP outcomes with a PV of 200-299 and ≥ 300 ml, two studies evaluated HoLEP outcomes with a PV > 175 ml. We observed improvement in postoperative functional outcomes in patients with a PV > 175, >200 and >300 ml. The retreatment rate was 0-1.3% in all studies involving prostate size ≥175 ml. Most of the complications were Clavien-Dindo I (%0-9) and II (%12.7-16.6).

Conclusions

Laser-based EEP is an efficient, safe and feasible procedure even in very large prostates with good functional outcomes, low perioperative complication and retreatment rates.

Informations de copyright

© 2022 The Authors.

Déclaration de conflit d'intérêts

A. Miernik receives research funds of the German 10.13039/501100002347Federal Ministry of Education and Research, Berlin (D). He receives support for his travel activities from the European Society of Urology, Arnhem (NL), and the 10.13039/501100006186German Society of Urology, Düsseldorf (D). Furthermore, A. Miernik is consulted for: KLS Martin, Tuttlingen (D), Avateramedical, Jena (D), LISA LaserProducts GmbH, Katlenburg-Lindau (D), Schoellyfiberoptics GmbH, Denzlingen (D), Dornier MedTech Laser GmbH (D), Medi-Tate Ltd. (IL, USA) and B. BraunNewventures GmbH, Freiburg (D). A. Miernik is speaker for the companies Richard Wolf GmbH (D) and Boston Scientific (USA). Additionally, he performed expert activities for the Ludwig Boltzmann Gesellschaft, Wien (A). A. Miernik is involved in numerous patents and inventions in the field of medical technology. C. Gratzke is advisor for Astellas Pharma GmbH, Munich (D), Ipsen Pharma GmbH, Munich (D), Steba Biotech S.A., Luxembourg (LUX), Bayer Pharma, Leverkusen (D), Olympus Winter &Ibe GmbH, Hamburg (D), Medi-Tate Ltd., Or Akiva (IL), MSD, Haar (D), Astra-Zeneca, Cambridge (UK) and Roche, Basel (CH). C. Gratzke receives speaker fees from 10.13039/100002429Amgen, California (10.13039/100011408USA), 10.13039/501100004948Astellas Pharma GmbH, Munich (D), 10.13039/501100014382Ipsen Pharma GmbH, Munich (D), 10.13039/100015756Janssen-Cilag GmbH, Neuss (D), 10.13039/100004326Bayer Pharma, Leverkusen (D), Takeda Pharmaceuticals, Tokio (JPN) and 10.13039/501100014841medac GmbH, Wedel (D). MY, MK, HCA, MFB, ST, and TT declare to have no conflicts of interest.