Endoscopic enucleation vs. robot-assisted simple prostatectomy for large prostates: a systematic review and...

Since Endoscopic Enucleation of the Prostate [EEP] and Robot-Assisted Simple Prostatectomy [RASP] showed comparable functional results, treatment selection is often based on clinicians' and patients' preferences. The aim of this systematic review was to compare Patient-Reported Outcomes Measures [PROMs] and Patient-Reported Experience Measures [PREMs] in patients with large prostate glands treated with EEP and RASP.

Literature search was performed on August 29^th 2024 using the MEDLINE, EMBASE, and Cochrane CENTRAL databases, following the EAU Guidelines Office and the PRISMA statement recommendations. All comparative studies reporting validated PROMs/PREMs for both interventions (EEP and RASP) were included. Studies reporting within-treatment comparisons only (e.g., HoLEP vs. ThuLEP) were excluded.

Ten studies involving 1105 patients (430 RASP, 675 EEP) were included in this systematic review. Follow-up ranged from 2 to 24 months. Considering urinary function, all authors reported a great improvement for both EEP and RASP at short- and mid-term, with no significant differences between endoscopic and robotic procedures. Alongside the lower symptom scores, patient-reported Quality of Life [QoL] significantly improved for both techniques. Erectile function remained stable after EEP and RASP in most of the studies, while some of them even reported a significant improvement. No studies reporting PREMs were retrieved.

Both RASP and EEP led to a great improvement in urinary function and QoL, safeguarding sexual function, with no significant difference between the different techniques in terms of functional outcomes. None of the included studies reported PREMs. A standardization of PROMs/PREMs and their integration in clinical practice is warranted, to understand the real impact of these treatments, helping physicians and patients for an individualized shared decision-making process.