Introduction <p>Benign prostatic obstruction (BPO) is a common condition. Anatomical endoscopic enucleation of the prostate (EEP) is the mainstay in therapy for large glands (&gt; 80 ml), but also feasible in smaller prostates. The original three-lobe enucleation technique has been supplemented by two-lobe and one-lobe or en-bloc techniques. One- and two-lobe techniques seem more effective in terms of surgical time and blood loss. The impact of the different techniques on functional outcomes however is unclear.</p> Objective <p>To determine whether the technique used in prostate enucleation influences functional outcomes of surgery.</p> Methods <p>We performed a systematic review of Medline/Pubmed and identified 124 studies, of which 10 were included for network meta-analyses. We included RCTs as well as retrospective and prospective cohort series, comparing one-lobe, two-lobe and three-lobe technique respectively. We assessed functional outcomes including post-void residual urine, Qmax (ml/s), IPSS Score and QoL Score. Additionally we compared stress and urge incontinence rates after three months.</p> Results <p>The only significantly differing result was in postoperative Qmax increase in favor of one-lobe and two-lobe compared to three-lobe technique. However, with mean differences of 0.989 and 0.749 respectively the effect was clinically negligible. There was no difference in the other functional outcomes including incontinence rates.</p> Limitations <p>Our approach is limited by the quality of the data, since retrospective and non-randomized trials were included due to the overall poor amount of studies on the subject.</p> Conclusion <p>One-lobe/en-bloc, two-lobe and three-lobe technique in endoscopic enucleation of the prostate for benign prostate syndrome all improve micturition. No final conclusion concerning superiority of a specific lobe-technique in terms of functional outcomes can be drawn from the available data. Randomized controlled trials are needed.</p>