Different lasers in the treatment of benign prostatic hyperplasia: a network meta-analysis

Abstract

All available surgical treatments for benign prostatic hyperplasia (BPH) have their individual advantages or disadvantages. However, the lack of head-to-head studies comparing different surgeries makes it unavailable to conduct direct analysis. To compare the efficacy and safety among different lasers and transurethral resection of prostate (TURP) for BPH, randomized controlled trials were searched in MEDLINE, EMBASE, Cochrane library, WHO International Clinical Trial Registration Platform, and Clinical Trial.gov by 2015.5; and the effectiveness-, perioperation- and complication-related outcomes were assessed by network meta-analysis. 36 studies involving 3831 patients were included. Holmium laser through resection and enucleation had the best efficacy in maximum flow rate. Thulium laser through vapo-resection was superior in improving international prostate symptom score and holmium laser through enucleation was the best for post-voiding residual volume improvement. Diode laser through vaporization was the rapidest in removing postoperative indwelling catheter, while TURP was the longest. TURP required the longest hospitalization and thulium laser through vapo-resection was relatively shorter. Holmium and thulium lasers seem to be relatively better in surgical efficacy and safety, so that these two lasers might be preferred in selection of optimal laser surgery. Actually, more large-scale and high quality head-to-head RCTs are suggested to validate the conclusions.

A pilot study of the shapes of ablation lesions in the canine prostate by laser, radiofrequency and microwave and their clinical significance

“…Minimally invasive local therapy possesses several dominant advantages, including minimal invasiveness, repeatability, and low incidence of side effects. Therefore, this method has received increasing attention and has been extensively applied in clinical practice [6,7]. Laser ablation (LA), radiofrequency ablation (RFA) and microwave ablation (MWA) are local therapy of thermal ablation techniques that can cause high temperatures and irreversible damage within tissues [8,9].…”

Heat injured stromal cells‐derived exosomal EGFR enhances prostatic wound healing after thulium laser resection through EMT and NF‐κB signaling

“…One treatment option for BPH and the related LUTS is transurethral resection of the prostate (TURP), although other medications, such as alpha blockers and 5α‐reductase inhibitors could also improve symptoms clinically. Moreover, various laser technologies have also been used by surgeons to treat BPH, which have various advantages, such as low morbidity and high efficiency . Thulium laser resection of the prostate (TmLRP) provides a safer and more efficient therapy for BPH as an alternative surgery to replace TURP .…”

“…Moreover, various laser technologies have also been used by surgeons to treat BPH, which have various advantages, such as low morbidity and high efficiency. 6 Thulium laser resection of the prostate (TmLRP) provides a safer and more efficient therapy for BPH as an alternative surgery to replace TURP. 7,8 However, TmLRP does have some disadvantages; dysuria, urgency, and even complications (bladder contracture and urethral stricture) occur in more than 23% of patients.…”

Different Chemotherapy Regimens in the Management of Advanced or Metastatic Urothelial Cancer: a Bayesian Network Meta-Analysis of Randomized Controlled Trials

“…Based on the detailed rankings of different chemotherapy regimens, direct and cumulative plots of rank probabilities were established [19,20]. The cumulative ranking curve (SUCRA) was also incorporated in our analysis for estimating the probability of a treatment being ranked at a specific place.…”