Holmium Laser Enucleation versus Transurethral Resection in Patients with Benign Prostate Hyperplasia: An Updated Systematic Review with Meta-Analysis and Trial Sequential Analysis

Abstract

BackgroundHolmium laser enucleation (HoLEP) in surgical treatment of benign prostate hyperplasia (BPH) potentially offers advantages over transurethral resection of the prostate (TURP).MethodsPublished randomized controlled trials (RCTs) were identified from PubMed, EMBASE, Science Citation Index, and the Cochrane Library up to October 10, 2013 (updated on February 5, 2014). After methodological quality assessment and data extraction, meta-analysis was performed using STATA 12.0 and Trial Sequential Analysis (TSA) 0.9 software.ResultsFifteen studies including 8 RCTs involving 855 patients met the criteria. The results of meta-analysis showed that: a) efficacy indicators: there was no significant difference in quality of life between the two groups (P>0.05), but compared with the TURP group, Qmax was better at 3 months and 12 months, PVR was less at 6, 12 months, and IPSS was lower at 12 months in the HoLEP, b) safety indicators: compared with the TURP, HoLEP had less blood transfusion (RR 0.17, 95% CI 0.06 to 0.47), but there was no significant difference in early and late postoperative complications (P>0.05), and c) perioperative indicators: HoLEP was associated with longer operation time (WMD 14.19 min, 95% CI 6.30 to 22.08 min), shorter catheterization time (WMD −19.97 h, 95% CI −24.24 to −15.70 h) and hospital stay (WMD −25.25 h, 95% CI −29.81 to −20.68 h).ConclusionsIn conventional meta-analyses, there is no clinically relevant difference in early and late postoperative complications between the two techniques, but HoLEP is preferable due to advantage in the curative effect, less blood transfusion rate, shorter catheterization duration time and hospital stay. However, trial sequential analysis does not allow us to draw any solid conclusion in overall clinical benefit comparison between the two approaches. Further large, well-designed, multicentre/international RCTs with long-term data and the comparison between the two approaches remain open.

Healthcare-Associated Infections after Lower Urinary Tract Endoscopic Surgery: Analysis of Risk Factors, Associated Microorganisms and Patterns of Antibiotic Resistance

“…Nevertheless, in a metaanalysis there were not differences found in terms of postoperative infection, although postoperative catheterization time was 5 h shorter in the HoLEP group [19]. More than 3 days postoperative catheterization could predispose to multiresistant infections [20].…”

Holmium laser enucleation of the prostate: patient selection and perspectives

“…In some cases, these medications cannot be bridged or held due to the risk of thrombotic and embolic complications. Several series have reported on the superiority of laser enucleation and vaporization procedures over TURP to treat BPH with regard to risk of bleeding complications 2,16–18. One series of 116 men undergoing PVP who continued oral aspirin, warfarin, or clopidogrel through surgery, given the risk of thromboembolic events, found no need for perioperative blood transfusions with similar decrease in postoperative hemoglobin compared to controls 19.…”

A Systematic Review and Meta-Analysis of Functional Outcomes and Complications Following the Photoselective Vaporization of the Prostate and Monopolar Transurethral Resection of the Prostate

“…A meta-analysis by Tan et al [30] found that HoLEP showed a similar voiding efficiency and a lower complication rate than MTURP. In other recent meta-analyses, the IPSS and Qmax scores after one year among patients treated with HoLEP were slightly better than among patients treated with MTURP [3132]. However, HoLEP has the disadvantage of requiring a substantial amount of training due to the technical challenges that it poses, and it can be dangerous for unskilled surgeons to perform this procedure [7].…”