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Updated: Jan 6, 2026
Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate HoLEP.
Published on: March 6, 2018
Prostatic Surgery With Preservation of the Supramonticular Tissue Versus Standard Surgery for Benign Prostatic
Giuston Mendoza-Chuctaya1, Kevin Rodrigo-Ramos1, Lucely Aycachi-Centeno2
1Escuela de Medicina, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru.
Background:
Benign prostatic surgery is a common intervention for the treatment of benign prostatic hyperplasia (BPH). Preservation of the supramonticular tissue during surgery has been proposed as a technique that could minimize complications and improve functional outcomes, such as sexual function and urinary continence. However, evidence regarding its benefits compared to standard techniques remains limited and contradictory.
Objective:
To compare modified surgery with supramonticular tissue preservation versus standard prostate surgery.
Methods:
For this systematic review, we conducted searches in PubMed, Scopus, Web of Science, and the Cochrane Library. We included randomized controlled trials (RCTs) comparing modified surgery with standard surgery. Two reviewers independently selected the studies. Meta-analyses were performed using RevMan 5.4, and the GRADE approach was used to assess the certainty of the evidence.
Results:
We found eight RCTs with 573 participants. Meta-analyses showed that the modified technique probably results in greater preservation of antegrade ejaculation (OR: 3.25; 95% CI: 2.56 to 4.11). However, it may have no effects on IPSS, maximum flow, QoL, post-void residual volume (PVR), and IIEF, with very low certainty of the evidence.
Conclusion:
In patients undergoing endoscopic surgery for BPH, surgery performed with the modified technique (supramonticular tissue preservation 1 cm above the verumontanum) probably results in increased preservation of antegrade ejaculation, and may have no effect on IPSS, maximum flow, QoL, PVR, and IIEF, with the evidence for these effects being very uncertain.
