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Greenlight high-performance system (HPS) 120-W laser vaporization versus transurethral resection of the prostate for the treatment of benign prostatic hyperplasia: a meta-analysis of the published results of randomized controlled trials

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Abstract

To assess the efficacy and the safety of GreenlightTM high-performance system (HPS) 120-W laser photoselective vaporization of the prostate (PVP) compared with transurethral resection of the prostate (TURP) for treatment of benign prostatic hyperplasia (BPH). The related original studies only including randomized controlled trials were searched by databases MEDLINE, EMBASE, Google Scholar, and the Cochrane Controlled Trial Register. The databases were updated till July 2014. The risk ratio, mean difference, and their corresponding 95 % confidence intervals were calculated. Risk of bias of the enrolled trials were assessed according to Cochrane Handbook. A total of four trials involving 559 patients were enrolled. Statistical analysis was performed by software Review Manager (V5.3.3). There was no significant difference in International Prostate Symptom Score (IPSS) and maximum flow rate (Qmax) between PVP and TURP at 6-, 12-, and 24-month follow-up. Patients in the PVP group were associated with significantly lower risk of capsule perforation (risk ratio (RR) = 0.06, 95 % confidence interval (95%CI) = 0.01 to 0.46; p = 0.007), significantly lower transfusion requirements (RR = 0.12, 95%CI = 0.03 to 0.43; p = 0.001), a shorter catheterization time (mean difference (MD) = −41.93, 95%CI = −54.87 to −28.99; p < 0.00001), and a shorter duration of hospital stay (MD = −2.09, 95%CI = −2.58 to −1.59; p < 0.00001) than that in the TURP group. In the TURP group, the patients were associated with a lower risk of re-operation (RR = 3.68, 95%CI = 1.04 to 13.00; p = 0.04) and a shorter operative time (MD = 9.28, 95%CI = 2.80 to 15.75; p = 0.005) than those in the PVP group. In addition, no statistically significant differences were detected between groups in terms of the rates of transurethral resection syndrome, urethral stricture, bladder neck contracture, incontinence, and infection. GreenlightTM 120-W laser PVP is as effective as TURP for symptom reduction and improvement of the quality of life. Laser PVP shows advantages over TURP in terms of intraoperative safety, whereas TURP is found to have a shorter operative time and lower re-operative risk.

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Abbreviations

AUR:

Acute urinary retention

BPH:

Benign prostatic hyperplasia

CIs:

Confidence intervals

DAN-PSSsex:

Danish Prostate Symptom Score Sexual Function Questionnaire

Ho:

Holmium

HPS:

High-performance system

IPSS:

International Prostate Symptom Score

LUTS:

Lower urinary tract symptoms

MD:

Mean difference

PSA:

Prostate-specific antigen

PVP:

Photoselective vaporization of the prostate

Qmax:

Maximum flow rate

RCTs:

Randomized controlled trials

RR:

Risk ratio

SD:

Standard deviation

Tm:

Thulium

TURP:

Transurethral resection of the prostate

XPS:

Xcelerated Performance System

YAG:

Yttrium aluminum garnet

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Authors and Affiliations

  1. Department of Urology, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Suzhou, Jiangsu, China

    Yan Zhou, Boxin Xue, Nadeem Ahmed Mohammad, Dong Chen, Xiaofei Sun, Jinhui Yang & Guangcheng Dai

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  1. Yan Zhou
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  2. Boxin Xue
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  3. Nadeem Ahmed Mohammad
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Correspondence to Boxin Xue.

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Zhou, Y., Xue, B., Mohammad, N.A. et al. Greenlight high-performance system (HPS) 120-W laser vaporization versus transurethral resection of the prostate for the treatment of benign prostatic hyperplasia: a meta-analysis of the published results of randomized controlled trials. Lasers Med Sci 31, 485–495 (2016). https://doi.org/10.1007/s10103-016-1895-x

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  • DOI: https://doi.org/10.1007/s10103-016-1895-x

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