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

Andrey Morozov, Mark Taratkin, Anastasia Shpikina, Yaron Ehrlich, Jonathan McFarland, Alim Dymov, Vasiliy Kozlov, Harun Fajkovic, Juan Gomez Rivas, Lukas Lusuardi, Jeremy Yuen Chun Teoh, Thomas Herrmann, Jack Baniel, Dmitry Enikeev*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


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, I 2 = 0%. Long-term Qmax and IPSS were significantly better for EEP. Q max pooled mean difference was 1.79 (95% CI 1.72–1.86) ml/s with a high concordance among the studies, I 2 = 0%. IPSS mean difference −1.24 (95% CI − 1.28 to − 1.2) points, I 2 = 57% but QoL did not differ, with mean difference being 0.01 (95% CI − 0.02 to 0.04), I 2 = 0%. IIEF-5 score was also significantly better for EEP, mean difference 1.08 (95% CI 1.03–1.13), but heterogeneity was high, I 2 = 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 (Q max and IPSS) at long term compared with TURP. It may also be beneficial in terms of IIEF-5, PVR, and PSA level.

Original languageEnglish
Pages (from-to)3471-3483
Number of pages13
JournalWorld Journal of Urology
Issue number12
StatePublished - Dec 2023


  • Benign prostate hyperplasia
  • Prostate enucleation
  • Systematic review
  • Transurethral prostate resection


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