Comparison of the efficacy and safety of transurethral laser versus open prostatectomy for patients with large-sized benign prostatic hyperplasia: A meta-analysis of comparative trials

Abstract

Purpose The selection of open prostatectomy (OP) over transurethral laser surgery is controversial for large volume prostates. Thus, we aim to compare the efficacy and safety of transurethral laser versus OP, and provide the latest evidence of clinical practice for large-sized benign prostatic hyperplasia (BPH). Materials and Methods This meta-analysis used Review Manager V5.3 software and the systematic literature search of Cochrane Library, Embase, PubMed, and Web of Science datasets was performed for citations published from 2000 to 2020 that compared transurethral laser with OP for the treatment of large BPH. Variables of interest assessing the two techniques included clinical characteristics, and the perioperation-, effectiveness-, and complication-related outcomes. Results The meta-analysis included twelve studies containing 1,514 patients, with 792 laser and 722 OP. The transurethral laser group was associated with shorter hospital stay and catheterization duration, and less hemoglobin decreased in the perioperative variables. There was no significant difference in the international prostate symptom score, post-void residual urine volume, maximum flow rate, and quality of life score. Transurethral laser group had a significantly lower incidence of blood transfusion than OP group (odds ratio, 0.10; 95% confidence interval, 0.05 to 0.19; p<0.001; I 2 =8%), and no statistical differences were found with respect to the other complications. Conclusions Both OP and transurethral laser prostatectomy are effective and safe treatments for large prostate adenomas. With these advantages of less blood loss and transfusion, and shorter catheterization time and hospital stay, laser may be a better choice for large BPH.

Prostatic Leiomyoma: An Uncommon Diagnosis Found in Clinically Suspected Cases of Severe Benign Prostatic Hyperplasia Without Elevated Serum Total Prostate-Specific Antigen Levels

“…TURP may present as an equally feasible treatment method when compared to an open simple prostatectomy procedure when managing large prostates [ 11 ]. While TURP procedures are associated with fewer blood transfusions and shorter hospital stays, they require longer operating times when compared to a simple prostatectomy [ 12 ].…”

Transurethral versus open enucleation of the prostate in Sweden – a retrospective comparative cohort study

“…Comparative studies [8][9][10][11][12] between any form of TUEP and OPE have shown that patients undergoing TUEP had less complications, shorter hospitalisation and shorter catheterisation compared to OPE, and with equivalent clinical short-term and long-term effects. In recent studies, also referred to in the EAU-guidelines (European Association of Urology), it has been shown that energy sources currently used in transurethral enucleation, Holmium laser (HolEP), Thulium laser (ThulEP) or bipolar current (BipolEP), show no superiority to one another at any endpoint, and therefore any of above technologies can be performed with equal validity and postoperative outcome [13][14][15][16][17][18].…”

The clinical efficacy of transurethral prostate resection in patients with Benign Prostatic Hyperplasia

“…Surgical treatment mainly includes two methods: minimally invasive surgery and open surgery. Although open surgery can alleviate the patient's condition to a certain extent, it causes signi cant trauma to the patient and is not conducive to their recovery [10].…”