Enucleation of the prostate for benign prostatic hyperplasia thulium laser versus holmium laser: a systematic review and meta-analysis
To evaluate the clinical efficacy and safety of thulium laser vapoenucleation/enucleation of the prostate (ThuEP) versus holmium laser enucleation of the prostate (HoLEP) in the management of benign prostatic hyperplasia (BPH). A systematic literature search was performed using PubMed, Embase, and Web of Science to identify eligible studies published before July 2018. Meta-analysis of extracted data was performed with RevMan version 5.3. We chose the fixed- or random-effect model to fit the pooled heterogeneity. Five eligible studies including two randomized controlled trials (RCTs) and three non-RCTs involving 1010 patients were enrolled in our meta-analysis. ThuEP provided less enucleation time when compared with HoLEP (WMD = − 7.73, 95% CI − 14.39–1.07, P = 0.02). During the 1st, 6th, and 12th months of postoperative follow-ups, statistically significant differences were found in Qmax (WMD = 2.05, 95% CI 0.52~3.58) and PVR (WMD = − 6.50, 95% CI − 7.35~− 5.66, P < 0.001) in the 1st month after the operation, also in IPSS (IPSS: WMD = − 1.29, 95% CI − 2.39~− 0.19, P = 0.02) in the 12th month after the operation. As regards other perioperative, postoperative parameters, and complication rates, we found no significant difference. Both ThuEP and HoLEP provided satisfactory micturition improvement with low morbidity after the 1st and 6th months of the operation. However, ThuEP showed higher enucleation efficacy and less intraoperative blood loss and may get a better outcome as compared to the HoLEP group in the early postoperative period with regard to Qmax/PVR and IPSS after the 1st and 12th months of the operation respectively.
KeywordsThulium laser Holmium laser Enucleation Safety Efficacy Meta-analysis
This study was supported by The National Natural Science Fund of China (81470927), National Natural Science Fund of China (81800667), and 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University.
Compliance with ethical standards
Meta-analysis does not require ethical review.
Meta-analysis does not require informed consent.
Conflict of interest
The authors declare that they have no conflict of interest.
- 2.Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A (2002) The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 21(2):167–178CrossRefGoogle Scholar
- 4.Foster H, Barry M, Dahm P, Gandhi M, Kaplan S, Kohler T, Lerner L, Lightner D, Parsons J, Roehrborn C, Welliver C, Wilt T, McVary K (2018) Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline. J UrolGoogle Scholar
- 7.NB D, M S, G R, G A, N T, G K, A R, A dLT, A D, R M (2016) Early results and complications of prostatic arterial embolization for benign prostatic hyperplasia.%A Lebdai S World journal of urology 34 (5):625–632Google Scholar
- 8.P B, MW V, LA K, L H, L M, DS E, TM K, HP S, D A (2018) Prostatic artery embolization versus standard surgical treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia: a systematic review and meta-analysis.%A Zumstein V. European urology focus undefined (undefined):undefinedGoogle Scholar
- 10.A T, N B, F dA, G M, U W, MO G, J B, JU S, A R, S P, H R, F A, C S, F B, W L, T L, NK G, R H, R M, A T, N S, S G, M H, K M, M S, C C, H K, A B (2016) A multicenter randomized noninferiority trial comparing GreenLight-XPS laser vaporization of the prostate and transurethral resection of the prostate for the treatment of benign prostatic obstruction: two-yr outcomes of the GOLIATH study.%A Thomas JA. Eur Urol 69 (1):94–102Google Scholar
- 12.Cornu J, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, McVary K, Novara G, Woo H, Madersbacher S (2015) A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol 67(6):1066–1096CrossRefGoogle Scholar
- 13.Li S, Zeng X, Ruan X, Weng H, Liu T, Wang X, Zhang C, Meng Z, Wang X (2014) Holmium laser enucleation versus transurethral resection in patients with benign prostate hyperplasia: an updated systematic review with meta-analysis and trial sequential analysis. PLoS One 9(7):e101615CrossRefGoogle Scholar
- 18.Herrmann T, Bach T, Imkamp F, Georgiou A, Burchardt M, Oelke M, Gross A (2010) Thulium laser enucleation of the prostate (ThuLEP): transurethral anatomical prostatectomy with laser support. Introduction of a novel technique for the treatment of benign prostatic obstruction. World J Urol 28(1):45–51CrossRefGoogle Scholar
- 22.Higgins J, Green SE (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration (Eds). Naunyn-Schmiedeberg's Arch Exp Pathol Pharmakol 5 (2):S38Google Scholar
- 23.Wells GA, Shea BJ, O'Connell D, Peterson J, Welch V, Losos M, Tugwell P (2012) The Newcastle–Ottawa Scale (NOS) for assessing the quality of non-randomized studies in meta-analysis. Applied Engineering in Agriculture 18 (6):págs. 727-734Google Scholar
- 24.Becker B, Herrmann T, Gross A, Netsch C (2018) Thulium vapoenucleation of the prostate versus holmium laser enucleation of the prostate for the treatment of large volume prostates: preliminary 6-month safety and efficacy results of a prospective randomized trial. World J UrolGoogle Scholar
- 25.Enikeev D, Glybochko P, Okhunov Z, Alyaev Y, Rapoport L, Tsarichenko D, Enikeev M, Sorokin N, Dymov A, Taratkin M (2018) Retrospective analysis of short-term outcomes after monopolar versus laser endoscopic enucleation of the prostate: a single center experience. J Endourol 32(5):417–423CrossRefGoogle Scholar
- 27.Hong K, Liu Y, Lu J, Xiao C, Huang Y, Ma L (2015) Effect and impact of holmium laser versus thulium laser enucleation of the prostate on erectile function. Zhonghua Nan Ke Xue 21(3):245–250Google Scholar