Although the transurethral resection of the prostate (TURP) has been regarded as the gold standard surgical option for lower urinary tract symptoms due to benign prostatic hyperplasia, the endoscopic enucleation of the prostate (EEP) with novel techniques is also recommended by the updated European Association of Urology (EAU) guidelines. However, whether there are differences on male sexual functions after these two procedures is still controversial.
We performed this meta-analysis to investigate the impact on erectile function and ejaculation of EEP and TURP (the protocol of this systematic review was published on www.crd.york.ac.uk/PROSPERO), and to explore the potential superiority between these two approaches. Literature search was conducted on Medline, Embase and the Cochrane library, to obtain all relevant randomized controlled trials published before December 13, 2018. Outcome data were pooled and analyzed with Review Manager 5.3 to compare the International Index of Erectile Function 5 (IIEF-5) scores and retrograde ejaculation rates from short to long term follow-ups.
Ten articles with 1435 patients were included. EEP group showed higher IIEF-5 scores than TURP group with mean difference (MD)=1.00, 95% confidence interval (CI): 0.95-1.05 at 48 months and MD=1.08, 95% CI: 1.03-1.13 at ≥60 months, respectively. In subgroup analysis, the holmium laser enucleation of the prostate showed significantly better IIEF scores than TURP group at 48 months (MD=1.00, 95% CI: 0.95-1.05) and ≥72 months (MD=1.08, 95% CI: 1.03-1.13). Additionally, no significant difference in retrograde ejaculation rate was found between EEP and TURP (RR=1.02, 95% CI: 0.85-1.23).
Compared with TURP, EEP may produce a more durable benefit for postoperative preservation of erectile function at long-term stage.