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25.07.2019 | Original Article | Ausgabe 5/2020

World Journal of Urology 5/2020

Bipolar endoscopic enucleation versus bipolar transurethral resection of the prostate: an ESUT systematic review and cumulative analysis

World Journal of Urology > Ausgabe 5/2020
Davide Arcaniolo, Celeste Manfredi, Alessandro Veccia, Thomas R. W. Herrmann, Estevão Lima, Vincenzo Mirone, Ferdinando Fusco, Cristian Fiori, Alessandro Antonelli, Jens Rassweiler, Evangelos Liatsikos, Francesco Porpiglia, Marco De Sio, Riccardo Autorino, EAU Section of Uro-Technology (ESUT) Research Group
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Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00345-019-02890-9) contains supplementary material, which is available to authorized users.
Davide Arcaniolo, Celeste Manfredi and Alessandro Veccia contributed equally to this work.

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To perform a cumulative analysis of the current evidence on the surgical and functional outcomes of bipolar endoscopic enucleation of the prostate (b-EEP) versus bipolar transurethral resection of the prostate (b-TURP).


A systematic review of the literature was performed on PubMed, Ovid®, and Scopus® according to Preferred Reporting Items for Systematic Review and Meta-analysis Statement (PRISMA Statement). The meta-analysis was conducted using the Review Manager 5.3 software. Parameters of interest were surgical and functional outcomes. Weighted mean difference, and odds ratio with 95% confidence interval were calculated for continuous and binary variables, respectively. Pooled estimates were calculated using the random-effect model.


Fourteen comparative studies were included. No statistically significant difference in terms of overall baseline characteristics was found. b-EEP had higher amount of resected tissue (p < 0.0001), shorter catheter time (p = 0.006), lower Hb drop (p = 0.03), and shorter length of stay (p < 0.0001). Equally, overall post-operative complications were lower (p = 0.01) as well as short (p = 0.04), and long-term complication rate (p = 0.04). There was higher re-intervention rate in the b-TURP group (p = 0.02) whereas b-EEP group had smaller residual prostate volume (p = 0.03), and lower post-operative PSA values (p < 0.00001). At long term, b-EEP presented lower IPSS (p = 0.04), higher Qmax (p = 0.002), and lower PVR (p < 0.00001).


b-EEP is an effective and safe surgical treatment for BPO. This procedure might offer several advantages over standard b-TURP, including the resection of a larger amount of tissue within the same operative time, shorter hospitalization, lower risk of complications, and lower re-intervention rate.
This was submitted to PROSPERO registry: CRD42019126748.

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