To systematically review studies comparing the overall efficacy and safety of lasers and bipolar technology for the transurethral treatment of benign prostatic enlargement (BPE).
A systematic review of the literature was completed in February 2018. Studies with comparative data between different lasers and bipolar technologies (enucleation or resection) were included in this review. A meta-analysis was performed using STATA 14.0, and subgroup analyses were also performed regarding the type of laser (holmium, thulium, green light and diode).
27 studies with 31 published articles (4382 patients) were selected for the meta-analysis. Compared with bipolar technology, lasers demonstrated shorter catheterization duration (standardized mean difference (SMD): 1.44; 95% CI 1.07–1.81; p < 0.001) and shorter hospital stay (SMD: 1.16; 95% CI 0.83–1.49; p < 0.001), and a smaller drop in hemoglobin (Hb) level (SMD: 0.86; 95% CI 0.47–1.26; p < 0.001). However, significant heterogeneity was detected in the studies and statistical significance was lost on sub-analyses. Furthermore, there were no significant differences between lasers and bipolar technology in the maximum flow rate (Qmax) and international prostate symptom score (IPSS) at a minimum of 3 months after treatment. Complications, including urethral stricture, urinary incontinence, urinary tract infection, re-catheterization and blood transfusion, did not significantly differ between lasers and bipolar technology.
Early efficacy and safety profiles were comparable between bipolar and laser treatments. Differences were observed in terms of smaller reduction in Hb, shorter catheterization duration and shorter hospital stay in favor of lasers. However, the smaller reduction in Hb, with lasers, did not translate into reduced transfusion requirements. Furthermore, there was significant heterogeneity in the studies and, in subgroup analyses, the differences were not statistically significant.
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This study was supported by the National Natural Science Foundation of China (NO. 81100464, 81200883 and 81570685), the General Financial Grant from the China Postdoctoral Science Foundation (NO. 2012M521410), the General Scientific and Technological project of Henan Province (201702031, 201702015), the Foundation of Henan Educational Committee (12A320061, 14A320097), the Scientific and Technological Innovation Project of Zhengzhou City (131PCXTD627), the Henan Natural Science Foundation, the Henan Postdoctoral Science Foundation of China, and the Youth Foundation for Medical Doctor of the First Affiliated Hospital of Zhengzhou University.
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Gu, C., Zhou, N., Gurung, P. et al. Lasers versus bipolar technology in the transurethral treatment of benign prostatic enlargement: a systematic review and meta-analysis of comparative studies. World J Urol 38, 907–918 (2020). https://doi.org/10.1007/s00345-019-02852-1