Efficacy and safety of enucleation vs. resection of prostate for treatment of benign prostatic hyperplasia: a meta-analysis of randomized controlled trials

The purpose of this study is to compare the efficacy and safety of transurethral enucleation and resection of prostate for treatment of benign prostatic hyperplasia (BPH). This meta-analysis was conducted through a systematic search before 1 September 2018. All included publications were randomized controlled trials (RCTs). Efficacy was evaluated based on International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), and quality of life (QoL). Perioperative data and complications postoperatively were also assessed. The quality assessment of included studies and results was performed by using the Cochrane System and GRADE (grading of recommendation assessment, development, and evaluation) System. Thirty-one publications involving 26 RCTs with 3283 patients were assessed in this review. The differences between enucleation and resection in IPSS, Qmax, and QoL at 1, 3, and 6 months postoperative were not significant. At 12 months postoperatively, IPSS and Qmax in the enucleation group were significantly better than those in the resection group. The results also suggested a benefit of enucleation over resection in hospital stay, hemoglobin loss, serum sodium decrease, blood transfusion rate, grade II, grade III complications, and early complications. However, resection exhibited a better operative time. Compared with resection, enucleation showed better efficacy and safety postoperatively with less hematological changes and severe complications, except for longer operative time.