Seth GS Medical College and KEM Hospital, Mumbai, India.
Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, 1120 NW 14th St #2107, 15th Floor, Miami, FL, 33136, USA.
World J Urol. 2024 Nov 5;42(1):625. doi: 10.1007/s00345-024-05315-4.
Open simple prostatectomy (OSP) has been a cornerstone in treating large prostate volumes (> 80 ml) in benign prostatic hyperplasia (BPH). With evolving minimally invasive procedures like minimally invasive simple prostatectomy (MISP) and laser enucleation, the role of OSP needs contemporary evaluation. This way, we assessed the efficacy and safety of OSP to understand its current standing in the treatment of BPH, especially in comparison with newer surgical modalities.
A comprehensive search of MEDLINE, Cochrane and EMBASE was conducted to include randomized controlled trials (RCTs) comparing OSP with other treatments for BPH from 1993 to 2023. A total of 10 RCTs were included in the meta-analysis. Data on various outcomes including IPSS, Qmax, PVR, quality of life, perioperative factors, and postoperative complications were analysed.
Our meta-analysis, covering 557 patients, confirms OSP's significant improvement in voiding symptoms and objective voiding metrics. However, it also reveals a higher incidence of postoperative complications, such as bleeding and transfusion requirements. The study found moderate to high heterogeneity in perioperative outcomes, indicating variations in surgical techniques and postoperative care. OSP remains a reliable option with an easily accessible and effective approach for managing large prostates, despite advancements in minimally invasive surgeries.
OSP continues to be a relevant surgical option for BPH in large prostates, offering significant symptom relief. However, the associated higher morbidity warrants careful patient selection and highlights the need for continued research into optimizing surgical techniques and improving outcomes.
开放性前列腺切除术（OSP）一直是治疗良性前列腺增生（BPH）中大前列腺体积（>80ml）的基石。随着微创技术如微创前列腺切除术（MISP）和激光前列腺剜除术的发展，OSP 的作用需要进行当代评估。通过这种方式，我们评估了 OSP 的疗效和安全性，以了解其在 BPH 治疗中的现状，特别是与较新的手术方式相比。
对 MEDLINE、Cochrane 和 EMBASE 进行了全面检索，纳入了 1993 年至 2023 年比较 OSP 与其他 BPH 治疗方法的随机对照试验（RCT）。共有 10 项 RCT 纳入了荟萃分析。对包括国际前列腺症状评分（IPSS）、最大尿流率（Qmax）、膀胱残余尿量（PVR）、生活质量、围手术期因素和术后并发症在内的各种结局进行了数据分析。
我们的荟萃分析涵盖了 557 名患者，证实 OSP 可显著改善排尿症状和客观排尿指标。然而，它也揭示了术后并发症（如出血和输血需求）发生率较高。研究发现，围手术期结局存在中到高度异质性，表明手术技术和术后护理存在差异。尽管微创手术有了进展，但 OSP 仍然是治疗大前列腺的一种可靠选择，具有易于获得和有效的方法。
OSP 仍然是大前列腺 BPH 的一种相关手术选择，可显著缓解症状。然而，相关的更高发病率需要仔细选择患者，并强调需要持续研究以优化手术技术并改善结局。
