Robot assisted simple prostatectomy versus endoscopic enucleation of the prostate: A systematic review and meta-analysis of comparative trials.

Robot assisted simple prostatectomy (RASP) and endoscopic enucleation of the prostate (EEP) are two minimally invasive alternatives to simple prostatectomy, which is considered the standard treatment in large prostate glands. It remains unclear which of the two is superior in terms of outcome and complications. To compare perioperative and functional outcomes of robot assisted simple prostatectomy (RASP) versus endoscopic enucleation of the prostate (EEP) systematic review and meta-analysis was conducted according to the recommendations of the Cochrane Collaboration and in line with the PRISMA criteria. The database search included clinicaltrials.gov, Medline (via PubMed), CINAHL and Web of Science and was using the PICO criteria. All comparative trials were considered. Risk of bias was assessed with the revised ROBINS-I tool. 760 studies were identified, four of which were eligible for qualitative and quantitative analysis, reporting on a total of 901 patients with follow-up up to 24 months. Hemoglobin drop (MD[CI]: 0.34 g/dl [0.09; 0.58]), the rate of blood transfusions (OR[CI]: 5.01 [1.60; 15.61]) catheterization time (MD[CI]: 3.26 d [1.30; 5.23]) and length of hospital stay (LoS) (MD[CI]: 1.94 d [1.11; 2.76]) were significantly lower in EEP. No significant differences were seen in operating time and enucleation weight. No significant differences were observed in the incidence of postoperative urinary retention, postoperative transient incontinence and complications graded according to the Clavien-Dindo Classification. Functional results were similar, with no significant differences in International Prostate Symptom Score and maximum urinary flow rate at follow-up. Conclusion: Both EEP and RASP offer excellent improvement of symptoms due to prostatic hyperplasia. EEP has lower blood loss, shorter catheterization time and LoS and should be the first choice if available. RASP remains an attractive alternative for extremely large glands, in concomitant diseases or whenever EEP is not available.

Journal of endourology. 2022 Jan 14 [Epub ahead of print]

Karl-Friedrich Kowalewski, Friedrich Otto Hartung, Jost Von Hardenberg, Caelan Haney, Maximilian Kriegmair, Philipp Nuhn, Paul Patroi, Niklas Westhoff, Patrick Honeck, T Herrmann, Maurice Stephan Michel, Jonas Herrmann

University Medical Center Mannheim, Heidelberg University, Department of Urology & Urosurgery, Mannheim, Germany; ., University Medical Center Mannheim, Heidelberg University, Department of Urology & Urosurgery, Mannheim, Baden-Württemberg, Germany; ., Department of Urology, University Hospital Mannheim, Mannheim, Germany, Mannheim, Germany; ., Universitätsklinikum Carl Gustav Carus Klinik und Poliklinik für Urologie, 536480, Dresden, Saxony, Germany; ., University Medical Center Mannheim, Heidelberg University, Department of Urology & Urosurgery Mannheim, DE, Mannheim, Germany; ., University Medical Center Mannheim, Heidelberg University, Department of Urology & Urosurgery Mannheim, DE, Mannheim, Germany; ., University Medical Center Mannheim, Heidelberg University, Mannheim, Germany; ., University Medical Center Mannheim, Heidelberg University, Department of Urology & Urosurgery Mannheim, DE Mannheim, DE, Mannheim, Germany; ., University Medical Center Mannheim, Heidelberg University, Department of Urology & Urosurgery Mannheim, DE, Mannheim, Germany; ., Hannover Medical School, Urology and Urooncology, Division of Endourology und minimal invasive therapy (MIT), Carl Neuberg Str. 1, Hannover, Germany, 30625., University Medical Center Mannheim, Heidelberg University, Department of Urology & Urosurgery Mannheim, DE Mannheim, DE, Mannheim, Germany; ., University Medical Center Mannheim, Heidelberg University, Department of Urology & Urosurgery, Mannheim, Germany; .

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