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Holmium laser technologies versus photoselective greenlight vaporization for patients with benign prostatichyperplasia: a meta-analysis

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Abstract

This study aims to compare the efficacy and safety of holmium laser technologies (HoL-Ts) and photoselective greenlight vaporization (PVP) for the treatment of benign prostatic hyperplasia (BPH), and to perform a meta-analysis according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses guidelines on PubMed, EMBASE, ClinicalTrial.gov, and the Cochrane Central Register of Controlled Trials up to August 2019. Functional outcomes, perioperative parameters, and complications were included and analyzed. Review Manager 5.3 (Cochrane Collaboration, Oxford, UK) was used to perform all analyses. A total of six articles composed of 2014 patients were included in this review. In comparison with PVP, HoL-Ts had a better performance in 1-, 3-, and 6-month Qmax (P = 0.02, but I2 = 81%), with less postvoid residual urine volume (PVR) (MD = −33.85, 95% CI −52.13 to −15.57, P = 0.0003) and less total energy used (MD = −31.66, 95% CI −58.99 to −4.33, P = 0.02). Moreover, HoL-Ts had a relatively lower risk of conversion rate (OR = 0.08, 95% CI 0.01 to 0.60, P = 0.01) associated with enough enucleation and less intraoperative bleeding. Subgroup analysis of holmium laser enucleation of prostate (HoLEP) versus PVP suggested that HoLEP presented better results in 1-, 3-, 6-month and 1-year Qmax with less PVR, less energy consumption, and lower conversion rate. Compared with PVP, HoL-Ts had higher 1-, 3-, and 6-month Qmax, less PVR, and less total energy consumption with a relatively lower risk of conversion rate. In subgroup analyses, HoLEP had shown better results in accordance with all HoL-Ts. Nevertheless, well-designed RCTs including overall functional indicators are required to confirm our findings.

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References

  1. 1.

    Berry SJ, Coffey DS, Walsh PC, Ewing LL (1984) The development of human benign prostatic hyperplasia with age. J Urol 132(3):474–479. https://doi.org/10.1016/s0022-5347(17)49698-4

  2. 2.

    Reich O, Gratzke C, Stief CG (2006) Techniques and long-term results of surgical procedures for BPH. Eur Urol 49(6):970–978. https://doi.org/10.1016/j.eururo.2005.12.072

  3. 3.

    Foster HE, Barry MJ, Dahm P, Gandhi MC, Kaplan SA, Kohler TS, Lerner LB, Lightner DJ, Parsons JK, Roehrborn CG, Welliver C, Wilt TJ, McVary KT (2018) Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline. J Urol 200(3):612–619. https://doi.org/10.1016/j.juro.2018.05.048

  4. 4.

    Oelke M, Bachmann A, Descazeaud A, Emberton M, Gravas S, Michel MC, N'Dow J, Nordling J, de la Rosette JJ (2013) EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 64(1):118–140. https://doi.org/10.1016/j.eururo.2013.03.004

  5. 5.

    Cornu J-N, 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):1066–1096. https://doi.org/10.1016/j.eururo.2014.06.017

  6. 6.

    Rassweiler J, Teber D, Kuntz R, Hofmann R (2006) Complications of transurethral resection of the prostate (TURP)—incidence, management, and prevention. Eur Urol 50(5):969–980. https://doi.org/10.1016/j.eururo.2005.12.042

  7. 7.

    Gilling PJ (2013) Laser Enucleation is increasingly becoming the standard of care for treatment of benign prostatic hyperplasia of all sizes. Eur Urol 63(5):868–869. https://doi.org/10.1016/j.eururo.2013.01.001

  8. 8.

    Yamada Y, Furusawa J, Sugimura Y, Kuromatsu I (2016) Photoselective vaporization of the prostate: long-term outcomes and safety during 10 years of follow-up. J Endourol 30(12):1306–1311. https://doi.org/10.1089/end.2016.0522

  9. 9.

    Elterman DS (2015) How I do it: GreenLight XPS 180W photoselective vaporization of the prostate. Can J Urol 22(3):7836–7843

  10. 10.

    Kuntzman RS, Malek RS, Barrett DM, Bostwick DG (1996) Potassium-titanyl-phosphate laser vaporization of the prostate: a comparative functional and pathologic study in canines. Urology 48(4):575–583. https://doi.org/10.1016/s0090-4295(96)00247-6

  11. 11.

    Zang YC, Deng XX, Yang DR, Xue BX, Xu LJ, Liu XL, Zhou YB, Shan YX (2016) Photoselective vaporization of the prostate with GreenLight 120-W laser versus transurethral resection of the prostate for benign prostatic hyperplasia: a systematic review with meta-analysis of randomized controlled trials. Lasers Med Sci 31(2):235–240. https://doi.org/10.1007/s10103-015-1843-1

  12. 12.

    Thangasamy IA, Chalasani V, Bachmann A, Woo HH (2012) Photoselective vaporisation of the prostate using 80-W and 120-W laser versus transurethral resection of the prostate for benign prostatic hyperplasia: a systematic review with meta-analysis from 2002 to 2012. Eur Urol 62(2):315–323. https://doi.org/10.1016/j.eururo.2012.04.051

  13. 13.

    Barski D, Richter M, Winter C, Arsov C, de Geeter P, Rabenalt R, Albers P (2013) Holmium laser ablation of the prostate (HoLAP): intermediate-term results of 144 patients. World J Urol 31(5):1253–1259. https://doi.org/10.1007/s00345-012-0901-6

  14. 14.

    Chilton CP, Mundy IP, Wiseman O (2000) Results of holmium laser resection of the prostate for benign prostatic hyperplasia. J Endourol 14(6):533–534. https://doi.org/10.1089/end.2000.14.533

  15. 15.

    Cornford PA, Biyani CS, Powell CS (1998) Transurethral incision of the prostate using the holmium:YAG laser: a catheterless procedure. J Urol 159(4):1229–1231

  16. 16.

    Gilling PJ, Mackey M, Cresswell M, Kennett K, Kabalin JN, Fraundorfer MR (1999) Holmium laser versus transurethral resection of the prostate: a randomized prospective trial with 1-year follow-up. J Urol 162(5):1640–1644

  17. 17.

    Gu C, Zhou N, Gurung P, Kou Y, Luo Y, Wang Y, Zhou H, Zhen C, Yang J, Tian F, Wu G (2019) Lasers versus bipolar technology in the transurethral treatment of benign prostatic enlargement: a systematic review and meta-analysis of comparative studies. World J Urol. https://doi.org/10.1007/s00345-019-02852-1

  18. 18.

    Li S, Zeng XT, Ruan XL, Weng H, Liu TZ, Wang X, Zhang C, Meng Z, Wang XH (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):e101615. https://doi.org/10.1371/journal.pone.0101615

  19. 19.

    Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535. https://doi.org/10.1136/bmj.b2535

  20. 20.

    Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928. https://doi.org/10.1136/bmj.d5928

  21. 21.

    Stang A (2010) Critical evaluation of the Newcastle–Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25(9):603–605. https://doi.org/10.1007/s10654-010-9491-z

  22. 22.

    Elmansy HM, Elzayat E, Elhilali MM (2010) Holmium laser ablation versus photoselective vaporization of prostate less than 60 cc: long-term results of a randomized trial. J Urol 184(5):2023–2028. https://doi.org/10.1016/j.juro.2010.06.107

  23. 23.

    Elmansy H, Baazeem A, Kotb A, Badawy H, Riad E, Emran A, Elhilali M (2012) Holmium laser enucleation versus photoselective vaporization for prostatic adenoma greater than 60 ml: preliminary results of a prospective, randomized clinical trial. J Urol 188(1):216–221. https://doi.org/10.1016/j.juro.2012.02.2576

  24. 24.

    Elshal AM, Elkoushy MA, Elmansy HM, Sampalis J, Elhilali MM (2014) Holmium:YAG transurethral incision versus laser photoselective vaporization for benign prostatic hyperplasia in a small prostate. J Urol 191(1):148–154. https://doi.org/10.1016/j.juro.2013.06.113

  25. 25.

    Jaeger CD, Mitchell CR, Mynderse LA, Krambeck AE (2015) Holmium laser enucleation (HoLEP) and photoselective vaporisation of the prostate (PVP) for patients with benign prostatic hyperplasia (BPH) and chronic urinary retention. BJU Int 115(2):295–299. https://doi.org/10.1111/bju.12674

  26. 26.

    Kim KS, Choi JB, Bae WJ, Kim SJ, Cho HJ, Hong SH, Lee JY, Kim SH, Kim HW, Cho SY, Kim SW (2016) Comparison of photoselective vaporization versus holmium laser enucleation for treatment of benign prostate hyperplasia in a small prostate volume. PLoS One 11(5):e0156133. https://doi.org/10.1371/journal.pone.0156133

  27. 27.

    Sun I, Yoo S, Park J, Yong Cho S, Jeong H, Son H, Oh SJ, Paick JS, Cho MC (2019) Quality of life after photo-selective vaporization and holmium-laser enucleation of the prostate: 5-year outcomes. Sci Rep 9(1):8261. https://doi.org/10.1038/s41598-019-44686-2

  28. 28.

    Egan KB (2016) The epidemiology of benign prostatic hyperplasia associated with lower urinary tract symptoms: prevalence and incident rates. Urol Clin North Am 43(3):289–297. https://doi.org/10.1016/j.ucl.2016.04.001

  29. 29.

    Lee AJ, Garraway WM, Simpson RJ, Fisher W, King D (1998) The natural history of untreated lower urinary tract symptoms in middle-aged and elderly men over a period of five years. Eur Urol 34(4):325–332

  30. 30.

    Elshal AM, Elkoushy MA, El-Nahas AR, Shoma AM, Nabeeh A, Carrier S, Elhilali MM (2015) GreenLight laser (XPS) photoselective vapo-enucleation versus holmium laser enucleation of the prostate for the treatment of symptomatic benign prostatic hyperplasia: a randomized controlled study. J Urol 193(3):927–934. https://doi.org/10.1016/j.juro.2014.09.097

  31. 31.

    Knapp GL, Chalasani V, Woo HH (2017) Perioperative adverse events in patients on continued anticoagulation undergoing photoselective vaporisation of the prostate with the 180-W Greenlight lithium triborate laser. BJU Int 119(Suppl 5):33–38. https://doi.org/10.1111/bju.13822

  32. 32.

    Zheng X, Qiu Y, Qiu S, Tang L, Nong K, Han X, Li M, Quan L, Yang L, Wei Q (2019) Photoselective vaporization has comparative efficacy and safety among high-risk benign prostate hyperplasia patients on or off systematic anticoagulation: a meta-analysis. World J Urol 37(7):1377–1387. https://doi.org/10.1007/s00345-018-2530-1

  33. 33.

    El Tayeb MM, Jacob JM, Bhojani N, Bammerlin E, Lingeman JE (2016) Holmium laser Enucleation of the prostate in patients requiring anticoagulation. J Endourol 30(7):805–809. https://doi.org/10.1089/end.2016.0070

  34. 34.

    Glybochko PV, Rapoport LM, Enikeev ME, Enikeev DV (2017) Holmium laser enucleation of the prostate (HoLEP) for small, large and giant prostatic hyperplasia: tips and tricks. Urologia 84(3):169–173. https://doi.org/10.5301/uj.5000232

  35. 35.

    Hueber PA, Bienz MN, Valdivieso R, Lavigueur-Blouin H, Misrai V, Rutman M, Te AE, Chughtai B, Barber NJ, Emara AM, Munver R, Trinh QD, Zorn KC (2015) Photoselective vaporization of the prostate for benign prostatic hyperplasia using the 180 watt system: multicenter study of the impact of prostate size on safety and outcomes. J Urol 194(2):462–469. https://doi.org/10.1016/j.juro.2015.03.113

  36. 36.

    Robert G, Cornu JN, Fourmarier M, Saussine C, Descazeaud A, Azzouzi AR, Vicaut E, Lukacs B (2016) Multicentre prospective evaluation of the learning curve of holmium laser enucleation of the prostate (HoLEP). BJU Int 117(3):495–499. https://doi.org/10.1111/bju.13124

  37. 37.

    Bastard C, Zorn K, Peyronnet B, Hueber PA, Pradere B, Roupret M, Misrai V (2019) Assessment of learning curves for 180-W GreenLight XPS photoselective vaporisation of the prostate: a multicentre study. Eur Urol Focus 5(2):266–272. https://doi.org/10.1016/j.euf.2017.09.011

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Acknowledgments

We appreciated Kai-yuen Fong for English editing. This study was funded by the National Natural Science Fund of China (grant no. 81770673) and 1.3.5. project for disciplines of excellence, West China Hospital, Sichuan University (grant no. ZY2017310).

Author information

L.P., X.Z., and D.L. contributed to the study conception and design. Material preparation, data collection, and analysis were performed by L.P., J.W., Q.H., G.C., T.L., H.S., and X.Z. The first draft of the manuscript was written by L.P. and X.Z. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Correspondence to De-yi Luo.

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Peng, L., Zheng, X., Wu, J. et al. Holmium laser technologies versus photoselective greenlight vaporization for patients with benign prostatichyperplasia: a meta-analysis. Lasers Med Sci (2020). https://doi.org/10.1007/s10103-020-02953-z

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Keywords

  • Laser therapy
  • Prostate
  • Holmium laser technologies
  • Greenlight photoselective vaporization
  • Prostatic hyperplasia
  • Meta-analysis