Safety and effectiveness of transurethral holmium laser enucleation of the prostate <i>versus</i> transurethral plasma kinetic enucleation of the prostate in the treatment of benign prostatic hyperplasia: a systematic review_West China Medical Journal

Authors：

PENG Lei ¹ , LI Jinze ² , YOU Chengyu ¹ , LI Xianhui ¹ , CHENG Bo ³ ,  LI Yunxiang ¹

1. Department of Urology, Nanchong Central Hospital, the Second Affiliated Medical College, North Sichuan Medical College (University), Nanchong, Sichuan 637000, P. R. China;
2. Department of Urology / Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;

Corresponding?author：

LI Yunxiang, Email: liyunxiang369@126.com

Keywords：

Holmium laser enucleation of the prostate; Plasmakinetic enucleation of the prostate; Benign prostate hyperplasia; Randomized controlled trials; Meta-analysis

DOI：

10.7507/1002-0179.201911222

Video：

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Objective To evaluate the safety and clinical efficacy of transurethral holmium laser enucleation of the prostate (HoLEP) versus transurethral plasma kinetic enucleation of the prostate (PKEP) in the treatment of benign prostate hyperplasia (BPH).Methods Randomized controlled trials of HoLEP versus PKEP in the treatment of BPH published between January 2000 and March 2021 were searched in PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Chongqing VIP database, and Wanfang database. Operative duration, estimated intraoperative blood loss, average duration of urinary catheterization, average duration of bladder irrigation, average length of hospital stay, and postoperative complications were used as safety evaluation indicators. Postoperative International Prostatic Symptomatic Score (IPSS), postoperative maximum urinary flow rate (Qmax), postoperative quality of life (QoL), and postvoid residual (PVR) were used as effective evaluation indicators.Results A total of 14 randomized controlled trials were included in this study, with a total of 1 478 patients (744 in the HoLEP group and 734 in the PKEP group). The results of the meta-analysis showed that the intraoperative blood loss in the HoLEP group was less than that in the PKEP group [weighted mean difference (WMD)=?25.95 mL, 95% confidence interval (CI) (?31.65, 20.25) mL, P=0.025], the average duration of urinary catheterization [WMD=?10.35 h, 95%CI (?18.25, ?2.45) h, P=0.042], average duration of bladder irrigation [WMD=?10.28 h, 95%CI (?17.52, ?3.04) h, P=0.038], and average length of hospital stay [WMD=?1.24 d, 95%CI (?1.85, ?0.62) d, P=0.033] in the HoLEP group were shorter than those in the PKEP group, and the incidence of postoperative complications [risk ratio=0.70, 95%CI (0.56, 0.87), P=0.047] and 6-month postoperative Qmax [WMD=?0.89 m/s, 95%CI (?1.74, ?0.05) m/s, P=0.037] in the HoLEP group were lower than those in the PKEP group. However, there was no significant difference in the operative duration, 3-month postoperative IPSS, 3-month postoperative Qmax, 3-month postoperative QoL, 3-month postoperative PVR, 6-month postoperative IPSS, 6-month postoperative QoL, or 6-month postoperative PVR between the two groups (P>0.05).Conclusions In the treatment of BPH, the effectiveness of HoLEP does not differ from that of PKEP, but HoLEP is safer. The conclusions of this study need to be verified in more precisely designed and larger sample-sized multi-center randomized controlled trials.

Citation： PENG Lei, LI Jinze, YOU Chengyu, LI Xianhui, CHENG Bo, LI Yunxiang. Safety and effectiveness of transurethral holmium laser enucleation of the prostate versus transurethral plasma kinetic enucleation of the prostate in the treatment of benign prostatic hyperplasia: a systematic review. West China Medical Journal, 2021, 36(7): 919-929. doi: 10.7507/1002-0179.201911222 Copy

1.	Gazel E, Kaya E, Yalcin S, et al. Comparison of the efficacy of holmium laser enucleation of the prostate in treating prostate volumes of ≤80 and > 80 mL. Urol Int, 2019, 102(3): 306-310.
2.	Johnsen NV, Kammann TJ, Marien T, et al. Comparison of holmium laser prostate enucleation outcomes in patients with or without preoperative urinary retention. J Urol, 2016, 195(4 Pt 1): 1021-1026.
3.	Li S, Kwong JS, Zeng XT, et al. Plasmakinetic resection technology for the treatment of benign prostatic hyperplasia: evidence from a systematic review and meta-analysis. Sci Rep, 2015, 5: 12002.
4.	Deng Z, Sun M, Zhu Y, et al. Thulium laser VapoResection of the prostate versus traditional transurethral resection of the prostate or transurethral plasmakinetic resection of prostate for benign prostatic obstruction: a systematic review and meta-analysis. World J Urol, 2018, 36(9): 1355-1364.
5.	Neill MG, Gilling PJ, Kennett KM, et al. Randomized trial comparing holmium laser enucleation of prostate with plasmakinetic enucleation of prostate for treatment of benign prostatic hyperplasia. Urology, 2006, 68(5): 1020-1024.
6.	Qian X, Liu H, Xu D, et al. Functional outcomes and complications following B-TURP versus HoLEP for the treatment of benign prostatic hyperplasia: a review of the literature and Meta-analysis. Aging Male, 2017, 20(3): 184-191.
7.	夏術階, 錢雨鑫, 楊博宇. 良性前列腺增生癥激光治療的昨天、今天、明天. 現代泌尿外科雜志, 2019, 24(4): 252-255.
8.	王建文, 張孟冬, 平浩, 等. 前列腺等離子剜切術和鈥激光剜除術治療良性前列腺增生療效分析. 中華男科學雜志, 2018, 24(12): 1084-1088.
9.	潘杰, 梁健峰, 陳舉鋒, 等. 經尿道前列腺鈥激光剜除術與經尿道前列腺雙極等離子剜除術治療良性前列腺增生的近期療效比較. 中國臨床新醫學, 2019, 12(2): 158-161.
10.	張豪杰, 盛璐, 陳然, 等. 經尿道鈥激光前列腺剜除術與經尿道等離子前列腺剜除術治療前列腺增生的療效比較. 中國臨床醫學, 2016, 23(5): 636-639.
11.	Clark HD, Wells GA, Hu?t C, et al. Assessing the quality of randomized trials: reliability of the Jadad scale. Control Clin Trials, 1999, 20(5): 448-452.
12.	Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
13.	Wei Z, Tao Y, Gu M, et al. Plasma kinetic enucleation vs holmium laser enucleation for treating benign prostatic hyperplasia: a randomized controlled trial with a 3-year follow-up. J Endourol, 2021.
14.	程乃偉. 鈥激光前列腺剜除術與經尿道等離子前列腺剜除術治療良性前列腺增生的效果對比分析. 保健文匯, 2020(4): 283-284.
15.	黃應龍, 王金明, 李丹娜, 等. 主動保留尿控結構的HoLEP和TUPKEP療效對比分析. 臨床泌尿外科雜志, 2018, 33(9): 687-692.
16.	李樹人, 鄭鳴, 蔣慶祥, 等. 經尿道前列腺鈥激光剜除術聯合膀胱小切口與經尿道雙極等離子前列腺剜除術治療高危大體積前列腺增生的比較研究. 中國內鏡雜志, 2015, 21(10): 1028-1032.
17.	林磊. 鈥激光前列腺剜除術對良性前列腺增生患者術中出血量及術后生活質量的影響. 河南醫學研究, 2017, 26(9): 1614-1615.
18.	劉強, 茍險峰, 李建國, 等. 經尿道等離子與鈥激光前列腺剜除術治療良性前列腺增生的療效比較. 臨床醫藥文獻電子雜志, 2016, 3(20): 3969-3970.
19.	汪洋, 李志鵬, 蔡潛, 等. 經尿道前列腺等離子剜除術與前列腺鈥激光剜除術的近期療效比較. 昆明醫科大學學報, 2016, 37(3): 52-56.
20.	王繼前, 李超, 王永超, 等. 鈥激光前列腺剜除術(HOLEP)與TUKEP治療大體積良性前列腺增生療效比較. 中國醫療器械信息, 2019, 25(23): 88-90.
21.	王子鋒, 張宏, 楊群, 等. 鈥激光前列腺剜除術與經尿道等離子前列腺剜除電切術治療良性前列腺增生的效果對比. 中國綜合臨床, 2015, 31(9): 831-834.
22.	趙峰. 鈥激光前列腺剜除術與經尿道等離子前列腺剜除電切術治療良性前列腺增生的效果對比. 臨床醫藥文獻電子雜志, 2017, 4(83): 16312-16313.
23.	趙國瑛. 鈥激光前列腺剜除術與經尿道等離子前列腺剜除電切術治療良性前列腺增生患者的臨床效果分析. 四川生理科學雜志, 2021, 43(2): 204-206.
24.	Zang YC, Deng XX, Yang DR, et al. 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, 2016, 31(2): 235-240.
25.	Xu N, Chen SH, Xue XY, et al. Older age and larger prostate volume are associated with stress urinary incontinence after plasmakinetic enucleation of the prostate. Biomed Res Int, 2017, 2017: 6923290.
26.	Zhao C, Yang H, Chen Z, et al. Thulium laser resection versus plasmakinetic resection of prostates in the treatment of benign prostate hyperplasia: a meta-analysis. J Laparoendosc Adv Surg Tech A, 2016, 26(10): 789-798.
27.	Cornu JN, Ahyai S, Bachmann A, et al. 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, 2015, 67(6): 1066-1096.
28.	丁建東, 米磊, 王軍卿. 鈥激光剜除術的應用對良性前列腺增生治療的安全性和有效性分析. 基層醫學論壇, 2019, 23(10): 1365-1366.
29.	李國峰, 曹曉明. 激光和等離子技術在經尿道前列腺剜除術中的臨床應用進展. 現代泌尿外科雜志, 2018, 23(9): 718-721.
30.	Rivera ME, Lingeman JE, Krambeck AE. Holmium laser enucleation of the prostate. J Endourol, 2018, 32(S1): S7-S9.
31.	羅建庭. 經尿道鈥激光前列腺剜除術和經尿道前列腺電切術后療效對比的Meta分析. 中國藥物與臨床, 2019, 19(7): 1176-1177.
32.	Wang SJ, Mu XN, Chen J, et al. Plasmakinetic enucleation of prostate versus 160-W laser photoselective vaporization for the treatment of benign prostatic hyperplasia. Asian J Androl, 2017, 19(1): 15-19.
33.	朱自強. 良性前列腺增生最新研究進展. 臨床泌尿外科雜志, 2019, 34(5): 409-412.
34.	Das AK, Han TM, Hardacker TJ. Holmium laser enucleation of the prostate (HoLEP): size-independent gold standard for surgical management of benign prostatic hyperplasia. Can J Urol, 2020, 27(S3): 44-50.
35.	Feng L, Zhang D, Tian Y, et al. Thulium laser enucleation versus plasmakinetic enucleation of the prostate: a randomized trial of a single center. J Endourol, 2016, 30(6): 665-670.

1. Gazel E, Kaya E, Yalcin S, et al. Comparison of the efficacy of holmium laser enucleation of the prostate in treating prostate volumes of ≤80 and > 80 mL. Urol Int, 2019, 102(3): 306-310.
2. Johnsen NV, Kammann TJ, Marien T, et al. Comparison of holmium laser prostate enucleation outcomes in patients with or without preoperative urinary retention. J Urol, 2016, 195(4 Pt 1): 1021-1026.
3. Li S, Kwong JS, Zeng XT, et al. Plasmakinetic resection technology for the treatment of benign prostatic hyperplasia: evidence from a systematic review and meta-analysis. Sci Rep, 2015, 5: 12002.
4. Deng Z, Sun M, Zhu Y, et al. Thulium laser VapoResection of the prostate versus traditional transurethral resection of the prostate or transurethral plasmakinetic resection of prostate for benign prostatic obstruction: a systematic review and meta-analysis. World J Urol, 2018, 36(9): 1355-1364.
5. Neill MG, Gilling PJ, Kennett KM, et al. Randomized trial comparing holmium laser enucleation of prostate with plasmakinetic enucleation of prostate for treatment of benign prostatic hyperplasia. Urology, 2006, 68(5): 1020-1024.
6. Qian X, Liu H, Xu D, et al. Functional outcomes and complications following B-TURP versus HoLEP for the treatment of benign prostatic hyperplasia: a review of the literature and Meta-analysis. Aging Male, 2017, 20(3): 184-191.
7. 夏術階, 錢雨鑫, 楊博宇. 良性前列腺增生癥激光治療的昨天、今天、明天. 現代泌尿外科雜志, 2019, 24(4): 252-255.
8. 王建文, 張孟冬, 平浩, 等. 前列腺等離子剜切術和鈥激光剜除術治療良性前列腺增生療效分析. 中華男科學雜志, 2018, 24(12): 1084-1088.
9. 潘杰, 梁健峰, 陳舉鋒, 等. 經尿道前列腺鈥激光剜除術與經尿道前列腺雙極等離子剜除術治療良性前列腺增生的近期療效比較. 中國臨床新醫學, 2019, 12(2): 158-161.
10. 張豪杰, 盛璐, 陳然, 等. 經尿道鈥激光前列腺剜除術與經尿道等離子前列腺剜除術治療前列腺增生的療效比較. 中國臨床醫學, 2016, 23(5): 636-639.
11. Clark HD, Wells GA, Hu?t C, et al. Assessing the quality of randomized trials: reliability of the Jadad scale. Control Clin Trials, 1999, 20(5): 448-452.
12. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
13. Wei Z, Tao Y, Gu M, et al. Plasma kinetic enucleation vs holmium laser enucleation for treating benign prostatic hyperplasia: a randomized controlled trial with a 3-year follow-up. J Endourol, 2021.
14. 程乃偉. 鈥激光前列腺剜除術與經尿道等離子前列腺剜除術治療良性前列腺增生的效果對比分析. 保健文匯, 2020(4): 283-284.
15. 黃應龍, 王金明, 李丹娜, 等. 主動保留尿控結構的HoLEP和TUPKEP療效對比分析. 臨床泌尿外科雜志, 2018, 33(9): 687-692.
16. 李樹人, 鄭鳴, 蔣慶祥, 等. 經尿道前列腺鈥激光剜除術聯合膀胱小切口與經尿道雙極等離子前列腺剜除術治療高危大體積前列腺增生的比較研究. 中國內鏡雜志, 2015, 21(10): 1028-1032.
17. 林磊. 鈥激光前列腺剜除術對良性前列腺增生患者術中出血量及術后生活質量的影響. 河南醫學研究, 2017, 26(9): 1614-1615.
18. 劉強, 茍險峰, 李建國, 等. 經尿道等離子與鈥激光前列腺剜除術治療良性前列腺增生的療效比較. 臨床醫藥文獻電子雜志, 2016, 3(20): 3969-3970.
19. 汪洋, 李志鵬, 蔡潛, 等. 經尿道前列腺等離子剜除術與前列腺鈥激光剜除術的近期療效比較. 昆明醫科大學學報, 2016, 37(3): 52-56.
20. 王繼前, 李超, 王永超, 等. 鈥激光前列腺剜除術(HOLEP)與TUKEP治療大體積良性前列腺增生療效比較. 中國醫療器械信息, 2019, 25(23): 88-90.
21. 王子鋒, 張宏, 楊群, 等. 鈥激光前列腺剜除術與經尿道等離子前列腺剜除電切術治療良性前列腺增生的效果對比. 中國綜合臨床, 2015, 31(9): 831-834.
22. 趙峰. 鈥激光前列腺剜除術與經尿道等離子前列腺剜除電切術治療良性前列腺增生的效果對比. 臨床醫藥文獻電子雜志, 2017, 4(83): 16312-16313.
23. 趙國瑛. 鈥激光前列腺剜除術與經尿道等離子前列腺剜除電切術治療良性前列腺增生患者的臨床效果分析. 四川生理科學雜志, 2021, 43(2): 204-206.
24. Zang YC, Deng XX, Yang DR, et al. 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, 2016, 31(2): 235-240.
25. Xu N, Chen SH, Xue XY, et al. Older age and larger prostate volume are associated with stress urinary incontinence after plasmakinetic enucleation of the prostate. Biomed Res Int, 2017, 2017: 6923290.
26. Zhao C, Yang H, Chen Z, et al. Thulium laser resection versus plasmakinetic resection of prostates in the treatment of benign prostate hyperplasia: a meta-analysis. J Laparoendosc Adv Surg Tech A, 2016, 26(10): 789-798.
27. Cornu JN, Ahyai S, Bachmann A, et al. 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, 2015, 67(6): 1066-1096.
28. 丁建東, 米磊, 王軍卿. 鈥激光剜除術的應用對良性前列腺增生治療的安全性和有效性分析. 基層醫學論壇, 2019, 23(10): 1365-1366.
29. 李國峰, 曹曉明. 激光和等離子技術在經尿道前列腺剜除術中的臨床應用進展. 現代泌尿外科雜志, 2018, 23(9): 718-721.
30. Rivera ME, Lingeman JE, Krambeck AE. Holmium laser enucleation of the prostate. J Endourol, 2018, 32(S1): S7-S9.
31. 羅建庭. 經尿道鈥激光前列腺剜除術和經尿道前列腺電切術后療效對比的Meta分析. 中國藥物與臨床, 2019, 19(7): 1176-1177.
32. Wang SJ, Mu XN, Chen J, et al. Plasmakinetic enucleation of prostate versus 160-W laser photoselective vaporization for the treatment of benign prostatic hyperplasia. Asian J Androl, 2017, 19(1): 15-19.
33. 朱自強. 良性前列腺增生最新研究進展. 臨床泌尿外科雜志, 2019, 34(5): 409-412.
34. Das AK, Han TM, Hardacker TJ. Holmium laser enucleation of the prostate (HoLEP): size-independent gold standard for surgical management of benign prostatic hyperplasia. Can J Urol, 2020, 27(S3): 44-50.
35. Feng L, Zhang D, Tian Y, et al. Thulium laser enucleation versus plasmakinetic enucleation of the prostate: a randomized trial of a single center. J Endourol, 2016, 30(6): 665-670.

West China Medical Journal

Safety and effectiveness of transurethral holmium laser enucleation of the prostate versus transurethral plasma kinetic enucleation of the prostate in the treatment of benign prostatic hyperplasia: a systematic review

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