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01-09-2020 | Benign Prostatic Hypertrophy | Review Article

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

Authors: Liao Peng, Xiao-nan Zheng, Jia-pei Wu, Xiao Zeng, Qing He, Guo Chen, Tian-hai Lin, Hong Shen, De-yi Luo

Published in: Lasers in Medical Science | Issue 7/2020

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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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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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):1229–1231CrossRef

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):1640–1644CrossRef

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.

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMed

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):325–332CrossRef

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

Title: Holmium laser technologies versus photoselective greenlight vaporization for patients with benign prostatichyperplasia: a meta-analysis
Authors: Liao Peng
Xiao-nan Zheng
Jia-pei Wu
Xiao Zeng
Qing He
Guo Chen
Tian-hai Lin
Hong Shen
De-yi Luo
Publication date: 01-09-2020
Publisher: Springer London
Keywords: Benign Prostatic Hypertrophy
Benign Prostatic Hypertrophy
Transurethral Prostate Resection
Laser
Published in: Lasers in Medical Science / Issue 7/2020
Print ISSN: 0268-8921
Electronic ISSN: 1435-604X
DOI: https://doi.org/10.1007/s10103-020-02953-z

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

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