Prostatic surgery with preservation of the supramonticular tissue versus standard surgery in benign prostatic hyperplasia: a systematic review

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 Cochrane Library. Randomized controlled trials (RCTs) and quasi-experimental studies that compared modified surgery with standard surgery were included. 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 identified six studies (three RCTs and three quasi-experimental) with 336 participants. The meta-analyses showed that the modified technique may result in greater preservation of antegrade ejaculation (OR=3.12; 95% CI: 2.31 to 4.20) and may increase post-micturition residual volume (OR=4.54; 95% CI: -20.83 to 29.91). Additionally, it may have no effect on IPSS, maximum flow, and QoL. However, all these results had very low certainty of evidence. Conclusion: In patients undergoing endoscopic surgery for BPH, surgery performed with the modified technique (preserving supramonticular tissue 1 cm above the verum montanum) may result in increased preservation of antegrade ejaculation, may increase post-micturition residual volume, and may have no effect on IPSS, maximum flow, and QoL. However, the evidence for these effects is very uncertain.