[Prospective Multicentre Analysis of Prostate Enucleation in Patients with Prostate Volumes Below and Above 100 ml: 3-Year Follow-Up on Safety and Efficacy].

Abstract

Anatomical endoscopic enucleation of the prostate (AEEP) is an established surgical technique for the treatment of benign prostatic hyperplasia (BPH) and is increasingly adopted in clinical practice. This study aimed to prospectively compare intraoperative and long-term outcomes of AEEP in patients with prostate volumes below and above 100 ml. Key parameters included intraoperative conversion rates, 90-day complication rates, and 3-year follow-up data on reoperation rates, patient satisfaction, and involuntary urinary leakage.We analysed data from a prospective, multicentre registry of patients who underwent AEEP for BPH. Patients were divided into two groups: Group 1 (<100 ml) and Group 2 (>100 ml). Preoperative parameters such as age, prostate volume, and symptom severity were recorded. Intraoperative and postoperative complications occurring within a 90-day period were documented. The 3-year follow-up included an assessment of reoperation rates, patient satisfaction, and incontinence rate (defined as the daily use of incontinence pads).A total of 1,653 patients were included, with 1,251 assigned to Group 1 and 396 to Group 2. There were no significant differences in age or symptom severity between the groups, with the median prostate volume being 54 ml in Group 1 and 125 ml in Group 2. Intraoperative conversion rates were low in both groups (1.8% in Group 1 vs. 2.5% in Group 2). The 90-day complication rate, classified by the Clavien-Dindo system, was 40.1% in Group 1 and 52.4% in Group 2, with most complications being minor (Grade I-II). Severe complications (Grade III or higher) were rare and similarly distributed between the two groups. At 3 years, the reoperation rate was 9.1% in Group 1 and 6.4% in Group 2. Patient satisfaction remained high, with 82.3% in Group 1 and 90.5% in Group 2 reporting an improvement in quality of life two years postoperatively. The incidence of involuntary urinary leakage requiring the use of pads was 26% in Group 1 and 24.8% in Group 2 at the 3-year follow-up.This prospective, multicentre study demonstrates that AEEP is a safe and effective treatment for patients with BPH. The rate of urinary incontinence appears higher than that reported in the current literature, but it should be noted that not all cases constitute de novo incontinence. Both groups exhibited low intraoperative conversion rates, an acceptable complication profile, and comparable long-term outcomes with high patient satisfaction. These findings support the broad applicability of AEEP for both smaller and larger prostate volumes in clinical practice.