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Article Open Access

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

  • Authors:
    • Dhirajaya Dharma Kadar
    • Branson Thamran
    • Krisna Adhitya Wilantara Yusuf
  • View Affiliations / Copyright

    Affiliations: Department of Urology, Haji Adam Malik Hospital, Medan, North Sumatra 20136, Indonesia, Department of Urology, Dr. Cipto Mangunkusumo Hospital, Jakarta 10320, Indonesia
    Copyright: © Kadar et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
  • Article Number: 22
    |
    Published online on: February 10, 2026
       https://doi.org/10.3892/wasj.2026.437
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Abstract

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.
View Figures

Figure 1

Risk-of-bias assessment using the
ROBINS-I tool for included non-randomized studies. The domains
evaluated include confounding, selection of participants,
classification of interventions, deviations from intended
interventions, missing data, measurement of outcomes, and selection
of reported results. ROBINS, Risk of Bias in Non-randomized Studies
of Interventions.

Figure 2

PRISMA flow diagram of the study
selection process. The diagram depicts the identification,
screening, eligibility assessment and inclusion of studies for the
systematic review and meta-analysis.

Figure 3

Forest plot comparing duration of
surgery between apex-preserving and apex-dissection techniques.
Apex preservation was associated with a significantly shorter
duration of surgery (MD, -9.82 min; 95% CI, -13.91 to -5.73). The
studies shown are the following: Liu and Yang (15), Liang et al (16), Fujisaki et al (17) and Irani et al (18). PUMPA, preserved urethral mucosa at
the prostatic apex; TURP, transurethral resection of the prostate;
MD, mean difference; CI, confidence interval.

Figure 4

Forest plot of post-operative urinary
incontinence comparing preservation vs. non-preservation groups.
The apex-preservation group demonstrated significantly lower rates
of early postoperative incontinence (RR, 0.18; 95% CI, 0.07-0.46).
The studies shown are the following: Liu and Yang (15), Liang et al (16), Fujisaki et al (17) and Irani et al (18). PUMPA, preserved urethral mucosa at
the prostatic apex; TURP, transurethral resection of the prostate;
RR, relative risk; CI, confidence interval.

Figure 5

Forest plot of intraoperative blood
loss. Apex-preserving procedures showed reduced blood loss compared
with conventional dissection (MD, -65.37 ml; 95% CI, -121.97 to
-8.77). The studies shown are the following: Liu and Yang (15), Liang et al (16) and Irani et al (18). PUMPA, preserved urethral mucosa at
the prostatic apex; TURP, transurethral resection of the prostate;
MD, mean difference; CI, confidence interval.

Figure 6

Forest plot comparing prostate tissue
volume excised. No significant difference in resected prostate
volume was observed between the groups (MD, 0.69 g; 95% CI, -5.96
to 7.34). The studies shown are the following: Liang et al
(16) and Fujisaki et al
(17). PUMPA, preserved urethral
mucosa at the prostatic apex; TURP, transurethral resection of the
prostate; MD, mean difference; CI, confidence interval.

Figure 7

Forest plot of IPSS following
surgery. Postoperative IPSS values were comparable between
apex-preserving and apex-dissection groups (MD, -0.02; 95% CI,
-0.65 to 0.62). The studies shown are the following: Liu and Yang
(15), Liang et al
(16) and Irani et al
(18). IPSS, International
Prostate Symptom Score; PUMPA, preserved urethral mucosa at the
prostatic apex; TURP, transurethral resection of the prostate; MD,
mean difference; CI, confidence interval.

Figure 8

Forest plot of postoperative QoL
scores. QoL outcomes did not differ significantly between groups
(MD, -0.30; 95% CI, -0.50 to -0.11). The studies shown are the
following: Liu and Yang (15) and
Liang et al (16). QoL,
quality-of-life; PUMPA, preserved urethral mucosa at the prostatic
apex; TURP, transurethral resection of the prostate; MD, mean
difference; CI, confidence interval.

Figure 9

Forest plot of post-operative Qmax.
Qmax outcomes were similar between the two surgical techniques (MD,
0.11 ml/sec; 95% CI, -0.38 to 0.59). The studies shown are the
following: Liu and Yang (15),
Liang et al (16), Fujisaki
et al (17) and Irani et
al (18). Qmax, peak urinary
flow rate; PUMPA, preserved urethral mucosa at the prostatic apex;
TURP, transurethral resection of the prostate; MD, mean difference;
CI, confidence interval.

Figure 10

Leave-one-out sensitivity analysis
for post-operative urinary incontinence. The studies included are
the following: Liu and Yang (15),
Liang et al (16) and Irani
et al (18). Excluding the
study by Fujisaki et al (17) reduced heterogeneity and yielded a
pooled incontinence estimate of 0.06 (95% CI, 0.01 to 0.33),
confirming robustness.

Figure 11

Funnel plot assessing publication
bias for urinary incontinence outcomes. Demonstrates mild asymmetry
suggestive of small-study effects, although interpretation is
limited by the small number of included studies.
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Copy and paste a formatted citation
Spandidos Publications style
Kadar DD, Thamran B and Yusuf KA: Clinical efficacy of prostatic apex preservation vs. the non‑preserving method in the management of BPH: A systematic review and meta‑analysis. World Acad Sci J 8: 22, 2026.
APA
Kadar, D.D., Thamran, B., & Yusuf, K.A. (2026). Clinical efficacy of prostatic apex preservation vs. the non‑preserving method in the management of BPH: A systematic review and meta‑analysis. World Academy of Sciences Journal, 8, 22. https://doi.org/10.3892/wasj.2026.437
MLA
Kadar, D. D., Thamran, B., Yusuf, K. A."Clinical efficacy of prostatic apex preservation vs. the non‑preserving method in the management of BPH: A systematic review and meta‑analysis". World Academy of Sciences Journal 8.2 (2026): 22.
Chicago
Kadar, D. D., Thamran, B., Yusuf, K. A."Clinical efficacy of prostatic apex preservation vs. the non‑preserving method in the management of BPH: A systematic review and meta‑analysis". World Academy of Sciences Journal 8, no. 2 (2026): 22. https://doi.org/10.3892/wasj.2026.437
Copy and paste a formatted citation
x
Spandidos Publications style
Kadar DD, Thamran B and Yusuf KA: Clinical efficacy of prostatic apex preservation vs. the non‑preserving method in the management of BPH: A systematic review and meta‑analysis. World Acad Sci J 8: 22, 2026.
APA
Kadar, D.D., Thamran, B., & Yusuf, K.A. (2026). Clinical efficacy of prostatic apex preservation vs. the non‑preserving method in the management of BPH: A systematic review and meta‑analysis. World Academy of Sciences Journal, 8, 22. https://doi.org/10.3892/wasj.2026.437
MLA
Kadar, D. D., Thamran, B., Yusuf, K. A."Clinical efficacy of prostatic apex preservation vs. the non‑preserving method in the management of BPH: A systematic review and meta‑analysis". World Academy of Sciences Journal 8.2 (2026): 22.
Chicago
Kadar, D. D., Thamran, B., Yusuf, K. A."Clinical efficacy of prostatic apex preservation vs. the non‑preserving method in the management of BPH: A systematic review and meta‑analysis". World Academy of Sciences Journal 8, no. 2 (2026): 22. https://doi.org/10.3892/wasj.2026.437
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