Clinical efficacy of prostatic apex preservation vs. the non‑preserving method in the management of BPH: A systematic review and meta‑analysis

The present study was carried out to determine the efficacy of the apex preservation technique in the management of benign prostatic hyperplasia (BPH) complications following surgery. For this purpose, the PubMed, Embase and Cochrane Library electronic databases were widely searched for controlled trials published up to 2025. The ROBINS‑I tool was used to assess the risk of bias in the included studies. Funnel plots and Egger's regression test were applied for publication bias in the present study. GRADEpro was used to assess the quality of evidence. The results revealed that the surgery duration of the preserving technique was significantly shorter [mean difference (MD), ‑9.82; 95% confidence interval (CI), ‑13.91 to ‑5.73; P<0.00001]. The preserving technique method was associated with a lower incontinence rate (relative risk, 0.18; 95% CI, 0.07 to 0.46; P=0.0004). Blood loss in the preserving technique group was also less (MD, ‑65.37; 95% CI, ‑121.97 to ‑8.77; P=0.02). On the whole, as demonstrated herein, preserving the prostatic apex is also more time‑efficient, leading to a markedly lower risk of developing complications such as blood loss and quicker urinary continence recovery following catheter removal. This leads to improved patient satisfaction, while maintaining similar International Prostate Symptom Score, quality of life and peak urinary flow rate values. Therefore, further research is required in order to fully determine the clinical effects of prostatic apex preservation in BPH surgery in minimizing the rate of complications.