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Results from a global multicenter registry of 6193 patients to refine endoscopic anatomical enucleation of the prostate (REAP) by evaluating trends and outcomes and nuances of prostate enucleation in a real-world setting

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Abstract

Purpose

To collect a multicentric, global database to assess current preferences and outcomes for endoscopic enucleation of the prostate (EEP).

Methods

Endourologists experienced in EEP from across the globe were invited to participate in the creation of this retrospective registry. Surgical procedures were performed between January 2020 and August 2022. Inclusion criteria: lower urinary tract symptoms not responding to or worsening despite medical therapy and absolute indication for surgery. Exclusion criteria: prostate cancer, concomitant lower urinary tract surgery, previous prostate/urethral surgery, pelvic radiotherapy.

Results

Ten centers from 7 countries, involving 13 surgeons enrolled 6193 patients. Median age was 68 [62–74] years. 2326 (37.8%) patients had large prostates (> 80 cc). The most popular energy modality was the Holmium laser. The most common technique used for enucleation was the 2-lobe (48.8%). 86.2% of the procedures were performed under spinal anesthesia. Median operation time was 67 [50–95] minutes. Median postoperative catheter time was 2 [1, 3] days. Urinary tract infections were the most reported complications (4.7%) followed by acute urinary retention (4.1%). Post-operative bleeding needing additional intervention was reported in 0.9% of cases. 3 and 12-month follow-up visits showed improvement in symptoms and micturition parameters. Only 8 patients (1.4%) required redo surgery for residual adenoma. Stress urinary incontinence was reported in 53.9% of patients and after 3 months was found to persist in 16.2% of the cohort.

Conclusion

Our database contributes real-world data to support EEP as a truly well-established global, safe minimally invasive intervention and provides insights for further research.

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Data availability

Data are available on request from the authors.

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Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore

    Vineet Gauhar, Lie Kwok Ying, Biligere Sarvajit & Vladislav Petov

  2. Department of Urology and Robotic Surgery, ICUA-Clínica CEMTRO, Madrid, Spain

    Fernando Gómez Sancha & Moisés Rodríguez Socarrás

  3. Department of Urology, Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation

    Dmitry Enikeev & Vladislav Petov

  4. Vienna Medical University, Vienna, Austria

    Dmitry Enikeev

  5. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria

    Dmitry Enikeev

  6. Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Mario Sofer

  7. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Khi Yung Fong

  8. Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Canada

    Dean Elterman

  9. Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, TG, India

    Mallikarjuna Chiruvella & Mohammed Taif Bendigeri

  10. Urology Division, AkfaMedline Hospital, Tashkent, Uzbekistan

    Azimdjon N. Tursunkulov

  11. Department of Urology, Sai Urology Hospital and MGM Medical College, Aurangabad, India

    Abhay Mahajan

  12. Department of Urology, Sarvodaya Hospital and Research Centre, Faridabad, Haryana, India

    Tanuj Paul Bhatia

  13. Department of Urology and Andrology, Lomonosov Moscow State University, Moscow, Russian Federation

    Sorokin Nikolai Ivanovich

  14. Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russian Federation

    Nariman Gadzhiev

  15. Urology Unit, IRCCS INRCA, Ancona, Italy

    Marco Dellabella & Daniele Castellani

  16. Department of Urology, University Hospitals Southampton NHS Trust, Southampton, UK

    Bhaskar Kumar Somani

  17. Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Le Marche, Via Conca 71, 60126, Ancona, Italy

    Daniele Castellani

  18. Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland

    Thomas R. W. Herrmann

Authors
  1. Vineet Gauhar
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  2. Fernando Gómez Sancha
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  3. Dmitry Enikeev
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  4. Mario Sofer
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  5. Khi Yung Fong
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  6. Moisés Rodríguez Socarrás
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  7. Dean Elterman
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  8. Mallikarjuna Chiruvella
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  9. Mohammed Taif Bendigeri
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  10. Azimdjon N. Tursunkulov
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  11. Abhay Mahajan
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  12. Tanuj Paul Bhatia
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  13. Sorokin Nikolai Ivanovich
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  14. Nariman Gadzhiev
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  15. Lie Kwok Ying
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  16. Biligere Sarvajit
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  17. Marco Dellabella
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  18. Vladislav Petov
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  19. Bhaskar Kumar Somani
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  20. Daniele Castellani
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  21. Thomas R. W. Herrmann
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Contributions

Conception and design: VG, DC. Acquisition and analysis of data: MRS, LKY, BS, MD, DE, NG DC, MS, MC, MTB, ANT, AM, TPB, SNI, NG, MD, VP. Statistical analysis: KYF. Drafting of the manuscript: VG, DC. Critical revision for important intellectual content: FGS, DE, BKS, TRWH. All authors participated in manuscript writing, review, and approval of the final version of the manuscript for submission.

Corresponding author

Correspondence to Daniele Castellani.

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Conflict of interest

Fernando Gomez-Sancha is a consultant for Quanta System and Lumenis. Thomas R.W. Herrmann is a consultant for, has received honoraria from, and is involved in research collaboration with Karl Storz. Dean Elterman is a consultant/investigator for Astellas, Boston Scientific, Medtronic, Procept BioRobotics, Prodeon, Olympus, Resurge, Rivermark, Zenflow, and Urotronic.

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Institutional board review approval was obtained by the leading center (AINU 11/2022) and the remaining centers had approvals from their Institutional board.

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Gauhar, V., Gómez Sancha, F., Enikeev, D. et al. Results from a global multicenter registry of 6193 patients to refine endoscopic anatomical enucleation of the prostate (REAP) by evaluating trends and outcomes and nuances of prostate enucleation in a real-world setting. World J Urol 41, 3033–3040 (2023). https://doi.org/10.1007/s00345-023-04626-2

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