Real World Propensity Score Matched Analysis Evaluating the Influence of En-bloc Vs. Non En-bloc Techniques, Energy and Instrumentation on Enucleation Outcomes for Large and Very Large Prostates

Overview

Journal World J Urol

Specialty Urology

Date 2024 May 6

PMID 38710824

Authors

Patrick Juliebo-Jones

Vineet Gauhar

Daniele Castellani

Khi Yung Fong

Mario Sofer

Marek Zawadzki

Nariman Gadzhiev

Giacomo Maria Pirola

Abhay D Mahajan

Pankaj Nandkishore Maheshwari

Vigen Malkhasyan

Sarvajit Biligere

Mehmet Ilker Gokce

Luigo Cormio

Dmitry Enikeev

Fernando Gomez Sancha

Thomas R W Herrmann

Bhaskar K Somani

Affiliations

Soon will be listed here.

Abstract

Purpose: The primary aim of the study was to evaluate if en-bloc vs. non en-bloc made a difference to intra-, peri- and post-operative surgical outcomes of anatomical endoscopic enucleation (AEEP) in large (> 80 cc) and very large prostates (> 200 cc). The secondary aim was to determine the influence of energy and instruments used.

Methods: Data of patients with > 80 cc prostate who underwent surgery between 2019 and 2022 were obtained from 16 surgeons across 13 centres in 9 countries. Propensity score matching (PSM) was used to reduce confounding. Logistic regression was performed to evaluate factors associated with postoperative urinary incontinence (UI).

Results: 2512 patients were included with 991 patients undergoing en-bloc and 1521 patients undergoing non-en-bloc. PSM resulted in 481 patients in both groups. Total operation time was longer in the en-bloc group (p < 0.001), enucleation time was longer in the non en-bloc group (p < 0.001) but morcellation times were similar (p = 0.054). Overall, 30 day complication rate was higher in the non en-bloc group (16.4% vs. 11.4%; p = 0.032). Rate of late complications (> 30 days) was similar (2.3% vs. 2.5%; p > 0.99). There were no differences in rates of UI between the two groups. Multivariate analysis revealed that age, Qmax, pre-operative, post-void residual urine (PVRU) and total operative time were predictors of UI.

Conclusions: In experienced hands, AEEP in large prostates by the en-bloc technique yields a lower rate of complication and a slightly shorter operative time compared to the non en-bloc approach. However, it does not have an effect on rates of post-operative UI.

Citing Articles

Application trends and research hotspots of endoscopic enucleation of the prostate: a bibliometric and visualization analysis.

Lan X, Yu Z, Jiang R, Li Z, Yang L, Zhang K World J Urol. 2025; 43(1):140.

PMID: 40009250 DOI: 10.1007/s00345-024-05379-2.

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