Surgical treatment of large volume prostates: a matched pair analysis comparing the open, endoscopic (ThuVEP) and robotic approach



To compare open simple prostatectomy, endoscopic enucleation and laparoscopic, robot-assisted enucleation of high-volume prostate in terms of operation time, blood loss, transfusion and complication rates and early continence rates.

Material and methods

Patients with BPH treated endoscopically (ThuVEP, Hamburg and Hannover) or robotically (Mainz) were evaluated prospectively for prostate size, free flow and validated questionnaires (IPSS, QoL). 35 patients were matched to patients after open prostatectomy (Mainz) for age, prostate size, IPSS and QoL scores. Operation time was noted from the first cut to the last suture; blood loss was estimated by the drop of haemoglobin preoperatively and one day after surgery. Transfusion rates were documented. Early continence was estimated by pad use over the first 24 h after catheter removal. Statistical analysis was performed with SPSS 22.0.


No significant differences in prostate size, age and preoperative questionnaires were found (p > 0.3). Postoperative flow and the results of the questionnaires were significantly improved (all p < 0.05), without difference between the approaches (p > 0.8). Endoscopic surgery showed superiority in operation time (both p < 0.05); blood loss and transfusion rates were significantly lower compared to open surgery (both p < 0.01) and lower than in robotic surgery without reaching significance (p = 0.18, p = 0.36). Similar results were seen in early continence rates.


Due to our results, endoscopic surgery should be considered as first-line therapy unless there are comorbidities like diverticula and/or bladder calculi that can be easily treated simultaneously by robotic surgery. Against the background of these findings, indications favouring open surgery are getting sparse.

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Author information




SN: Project development, Data Collection, Data analysis, Manuscript writing. TB: Project development Manuscript editing Data Collection. TH: Project development Manuscript editing. SJ: Data Collection. FCR: Manuscript editing. CH: Manuscript editing. JWT: Manuscript editing. CT: Data analysis, Manuscript editing. AN: Project development, Data analysis, Manuscript editing.

Corresponding author

Correspondence to Sebastian Nestler.

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Conflict of interest

The authors were not compensated and retained the control over the content of the manuscript.

Research involving human participants

The study was performed in accordance with the ethical standards of the institutional research committee of each hospital.

Informed consent

Informed consent was obtained from all patients at time of follow-up.

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Nestler, S., Bach, T., Herrmann, T. et al. Surgical treatment of large volume prostates: a matched pair analysis comparing the open, endoscopic (ThuVEP) and robotic approach. World J Urol 37, 1927–1931 (2019).

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  • Bladder outlet obstruction
  • BPH
  • BPS
  • Laser enucleation
  • Robotic enucleation
  • Simple prostatectomy