Comparison of EEP and TURP long-term outcomes: systematic review and meta-analysis

OBJECTIVE

To compare long-term reoperation rate and functional outcomes between EEP (endoscopic enucleation of the prostate) and TURP (transurethral resection of the prostate).

EVIDENCE ACQUISITION

A systematic literature review of Medline, Scopus, and Web of Science was conducted with primary outcome assessed being reoperation rate and secondary outcomes after a long term (> 3 years) being functional outcomes or related values (prostate volume, PSA level, etc.).

EVIDENCE SYNTHESIS

Five studies were found with long-term follow-up 4-7 years. EEP reoperation rate ranged from 0 to 1.27%, while from 1.7 to 17.6% for TURP. Meta-analysis showed significantly lower OR for EEP, 0.27 (95% CI 0.24-0.31), with notable homogeneity of the results, I2 = 0%. Long-term Qmax and IPSS were significantly better for EEP. Qmax pooled mean difference was 1.79 (95% CI 1.72-1.86) ml/s with a high concordance among the studies, I2 = 0%. IPSS mean difference -1.24 (95% CI - 1.28 to - 1.2) points, I2 = 57% but QoL did not differ, with mean difference being 0.01 (95% CI - 0.02 to 0.04), I2 = 0%. IIEF-5 score was also significantly better for EEP, mean difference 1.08 (95% CI 1.03-1.13), but heterogeneity was high, I2 = 70%. PSA level and prostate volume were only reported in one study and favored EEP slightly yet statistically significant.

CONCLUSION

EEP had a significantly lower reoperation rate and better functional outcomes (Qmax and IPSS) at long term compared with TURP. It may also be beneficial in terms of IIEF-5, PVR, and PSA level.

Kidney Stones as Minerals: How Methods from Geology Could Inform Urolithiasis Treatment

Despite the recent advances in minimally invasive surgery, kidney stones still pose a significant clinical challenge due to their high recurrence rate of 50% in 5-10 years after the first stone episode. Using the methods of geosciences and biology, the GeoBioMed approach treats kidney stones as biogenic minerals, offering a novel perspective on their formation and dissolution processes. In this review, we discuss kidney stones' structural and mechanical properties as emerging biomarkers of urolithiasis, emphasizing the importance of a comprehensive stone analysis in developing personalized treatment strategies. By focusing on unexplored properties like crystalline architecture, porosity, permeability, cleavage, and fracture, alongside the conventionally used composition and morphology, we show how these stone characteristics influence the treatment efficacy and the disease recurrence. This review also highlights the potential of advanced imaging techniques to uncover novel biomarkers, contributing to a deeper understanding of stone pathogenesis. We discuss how the interdisciplinary collaboration within the GeoBioMed approach aims to enhance the diagnostic accuracy, improve the treatment outcomes, and reduce the recurrence of urolithiasis.