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Transurethral laser versus open simple prostatectomy for large volume prostates: a systematic review and meta-analysis of randomized controlled trials

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Abstract

The benefit of transurethral laser prostatectomy over open simple prostatectomy (OSP) is controversial in aged symptomatic benign prostatic hyperplasia (BPH) patients with large volume prostates, and the aim of this study is to compare the safety and efficiency of these two methods. Meta-analysis was applied using the Review Manager V5.3 software and the retrieved randomized controlled clinical trials (RCTs) comparing transurethral laser prostatectomy with OSP were analyzed for the treatment of large volume prostates from 2000 to 2019 in PubMed, Web of Science, Cochrane, and EMBASE datasets. Five RCTs assessing transurethral laser prostatectomy versus OSP were considered suitable for this meta-analysis, which included a total of 448 patients, with 232 patients undergoing laser and 216 patients undergoing OSP. Compared with OSP, although transurethral laser prostatectomy required a longer operative time (weighted mean difference (WMD) 27.49 mins; 95% confidence interval (CI) 16.54–38.44; P < 0.00001) and obtained a less resected prostate weight (WMD − 11.72 g; 95% CI − 21.75 to − 1.70; P = 0.02), patients undergoing laser prostatectomy benefited from significantly less hemoglobin decline (− 0.97 g/dL; 95% CI − 1.31 to − 0.64; P < 0.00001), shorter time of catheterization (WMD − 3.67 days; 95% CI − 5.60 to − 1.75; P = 0.0002), shorter length of hospital stay (WMD − 4.75 days; 95% CI − 6.57 to − 2.93; P < 0.00001), and less blood transfusion (odds ratio 0.10; 95% CI 0.03 to 0.35; P = 0.0003). During postoperative follow-up, no significant difference was observed between the two groups in IPSS, QoL, Qmax, and PVR. Both transurethral laser prostatectomy and OSP are safe and effective for large prostates that require prostate resection. Taking into account of less blood loss, shorter catheterization time and hospital stay, and less blood transfusion, transurethral laser prostatectomy may be a better treatment for patients with large prostates.

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Abbreviations

OSP:

open simple prostatectomy

BPH:

benign prostatic hyperplasia

RCT:

randomized controlled clinical trial

WMD:

weighted mean difference

CI:

confidence interval

IPSS:

International Prostate Symptom Score

QoL:

quality of life score

Qmax:

maximum flow rate

PVR:

post-void residual

LUTS:

lower urinary tract symptoms

HoLEP:

holmium laser enucleation of prostate

MD:

mean difference

OR:

odds ratio

AUR:

acute urinary retention

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Acknowledgments

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published.

Funding

This study was funded by the Medical Scientific Research Foundation of Zhejiang Province (Grant No. 2018KY019).

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Author notes

  1. Wei Haibin and Qian Lin contributed equally to this work.

Authors and Affiliations

  1. The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China

    Wei Haibin, Qian Lin, Wu Junxiu & Zhang Dahong

  2. Department of Urology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, No. 158, Shangtang Road, Xiacheng District, Hangzhou, 310014, Zhejiang, China

    Wei Haibin, Zhang Qi & Zhang Dahong

  3. Bengbu Medical College, Bengbu, 233030, Anhui, China

    Wang Heng

  4. Department of Gynecology, Zhejiang Provincial People’s Hospital, No. 158, Shangtang Road, Xiacheng District, Hangzhou, 310014, Zhejiang, China

    Wang Yanpeng

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  1. Wei Haibin
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Correspondence to Wang Yanpeng or Zhang Dahong.

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Haibin, W., Lin, Q., Junxiu, W. et al. Transurethral laser versus open simple prostatectomy for large volume prostates: a systematic review and meta-analysis of randomized controlled trials. Lasers Med Sci 36, 1191–1200 (2021). https://doi.org/10.1007/s10103-020-03153-5

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  • DOI: https://doi.org/10.1007/s10103-020-03153-5

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