A propensity score-matched comparison of medium- to long-term outcomes between plasmakinetic enucleation of the prostate and transurethral resection of the prostate for benign prostatic hyperplasia.

BACKGROUND: Transurethral resection of the prostate (TURP) remains the standard surgical treatment for benign prostatic hyperplasia (BPH), yet its the adoption of alternative techniques such as plasmakinetic enucleation of the prostate (PKEP). While PKEP has demonstrated favorable short-term outcomes, comparative evidence on mid- to long-term functional efficacy, safety, and the associated learning curve relative to TURP remains limited. This study aims to compare perioperative outcomes, mid-to-long-term functional efficacy, safety, and learning curves between PKEP and TURP in patients with BPH.

METHODS: A retrospective analysis was conducted on BPH patients treated between January 2017 and December 2022. Propensity score matching (PSM) with a 1:2 ratio and a caliper value of 0.10 was employed to balance baseline characteristics, resulting in 159 matched patients (53 in the PKEP group and 106 in the TURP group). Perioperative outcomes, along with International Prostate Symptom Score (IPSS), quality of life (QOL) score, maximum urinary flow rate (Qmax), post-void residual urine volume (PVR), and International Index of Erectile Function-5 (IIEF-5) scores were assessed at 3 to 24 months postoperatively. Complications were classified using the Clavien-Dindo grading system, and learning curves were analyzed using the cumulative sum (CUSUM) method.

RESULTS: The PKEP group demonstrated significantly shorter operative time, intraoperative irrigation fluid usage, postoperative bladder irrigation duration and volume, catheterization time, and hospital stay compared to the TURP group (all P<0.05). Additionally, the PKEP group experienced a significantly smaller reduction in postoperative hemoglobin levels (P=0.01). At 24 months postoperatively, the PKEP group achieved superior IPSS scores, Qmax, and IIEF-5 scores compared to the TURP group (IPSS: 6.00 vs. 8.00, P=0.01; Qmax: 24.06 vs. 22.46 mL/s, P=0.02; IIEF-5: 18.57 vs. 16.28, P=0.002). Furthermore, the PKEP group had a significantly lower incidence of erectile dysfunction and Clavien-Dindo II complications (both P<0.05). Learning curve analysis indicated that PKEP achieved surgical proficiency in efficiency (approximately 20 cases) and bleeding control more rapidly than TURP, with minimal or no initial learning phase required for bleeding control.

CONCLUSIONS: PKEP demonstrates comparable mid-to-long-term efficacy to TURP but offers advantages in terms of reduced invasiveness, higher perioperative efficiency and safety, and a lower incidence of Clavien-Dindo II complications.