Top

Published in:

01-04-2020 | Diode Laser | Review

Lasers versus bipolar technology in the transurethral treatment of benign prostatic enlargement: a systematic review and meta-analysis of comparative studies

Authors: Chaohui Gu, Naichun Zhou, Pratik Gurung, Yiping Kou, Yang Luo, Yidi Wang, Hui Zhou, Cheng Zhen, Jinjian Yang, Fengyan Tian, Guan Wu

Published in: World Journal of Urology | Issue 4/2020

Abstract

Purpose

To systematically review studies comparing the overall efficacy and safety of lasers and bipolar technology for the transurethral treatment of benign prostatic enlargement (BPE).

Methods

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).

Results

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.

Conclusion

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.

Mazur DJ, Helfand BT, McVary KT (2012) Influences of neuroregulatory factors on the development of lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction in aging men. Urol Clin N Am 39(1):77–88. https://doi.org/10.1016/j.ucl.2011.09.005 CrossRef

Gratzke C, Bachmann A, Descazeaud A, Drake MJ, Madersbacher S, Mamoulakis C, Oelke M, Tikkinen KAO, Gravas S (2015) EAU Guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 67(6):1099–1109. https://doi.org/10.1016/j.eururo.2014.12.038 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

American Urological Association (2018) Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia. https://www.auanet.org/guidelines/benign-prostatic-hyperplasia/lower-urinary-tract-symptoms-(2018). Accessed Nov 16 2018.

Reich O, Gratzke C, Bachmann A, Seitz M, Schlenker B, Hermanek P, Lack N, Stief CG (2008) Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol 180(1):246–249. https://doi.org/10.1016/j.juro.2008.03.058 CrossRefPubMed

Nair SM, Pimentel MA, Gilling PJ (2016) A review of laser treatment for symptomatic BPH (Benign Prostatic Hyperplasia). Curr Urol Rep 17(6):45. https://doi.org/10.1007/s11934-016-0603-5 CrossRefPubMed

da Silva RD, Bidikov L, Michaels W, Gustafson D, Molina WR, Kim FJ (2015) Bipolar energy in the treatment of benign prostatic hyperplasia: a current systematic review of the literature. Can J Urol 22(1):30–44PubMed

Cornu JN (2016) Bipolar, monopolar, photovaporization of the prostate, or holmium laser enucleation of the prostate: how to choose what's best? Urol Clin N Am 43(3):377–384. https://doi.org/10.1016/j.ucl.2016.04.006 CrossRef

Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:2535. https://doi.org/10.1136/bmj.b2535 CrossRef

10.

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

11.

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

12.

Chen YB, Chen Q, Wang Z, Peng YB, Ma LM, Zheng DC, Cai ZK, Li WJ, Ma LH (2013) A prospective, randomized clinical trial comparing plasmakinetic resection of the prostate with holmium laser enucleation of the prostate based on a 2-year followup. J Urol 189(1):217–222. https://doi.org/10.1016/j.juro.2012.08.087 CrossRefPubMed

13.

Fayad AS, Elsheikh MG, Zakaria T, Elfottoh HA, Alsergany R, Elshenoufy A, Elghamarawy H (2015) Holmium laser enucleation of the prostate versus bipolar resection of the prostate: a prospective randomized study. "Pros and Cons". Urology 86(5):1037–1041. https://doi.org/10.1016/j.urology.2015.08.004

14.

Fayad AS, Sheikh MG, Zakaria T, Elfottoh HA, Alsergany R (2011) Holmium laser enucleation versus bipolar resection of the prostate: a prospective randomized study. Which to choose? J Endourol 25 (8):1347–1352. https://doi.org/10.1089/end.2011.0059

15.

Neill MG, Gilling PJ, Kennett KM, Frampton CM, Westenberg AM, Fraundorfer MR, Wilson LC (2006) Randomized trial comparing holmium laser enucleation of prostate with plasmakinetic enucleation of prostate for treatment of benign prostatic hyperplasia. Urology 68(5):1020–1024. https://doi.org/10.1016/j.urology.2006.06.021 CrossRefPubMed

16.

Feng L, Zhang D, Tian Y, Song J (2016) Thulium laser enucleation versus plasmakinetic enucleation of the prostate: a randomized trial of a single center. J Endourol 30(6):665–670. https://doi.org/10.1089/end.2015.0867 CrossRefPubMed

17.

Kumar A, Vasudeva P, Kumar N, Nanda B, Jha SK, Mohanty N (2013) A prospective randomized comparative study of monopolar and bipolar transurethral resection of the prostate and photoselective vaporization of the prostate in patients who present with benign prostatic obstruction: a single center experience. J Endourol 27(10):1245–1253. https://doi.org/10.1089/end.2013.0216 CrossRefPubMed

18.

Kumar N, Vasudeva P, Kumar A, Singh H (2018) Prospective randomized comparison of monopolar TURP, bipolar TURP and photoselective vaporization of the prostate in patients with benign prostatic obstruction: 36 months outcome. Lower Urinary Tract Sympt 10(1):17–20. https://doi.org/10.1111/luts.12135 CrossRef

19.

Liu L, Lei JH, He QY, Li X, Yang L (2014) Evaluation of greenlight photoselective vaporization of prostate and plasmakinetic resection of prostate for the treatment of elderly benign prostatic hyperplasia men with high surgical risk: a prospective randomised control trial]. Sichuan da xue xue bao Yi xue ban. J Sichuan Univ Med Sci Ed 45(4):708-711

20.

Luo B, Xhao X, Lu L, Shi Y, Li X, Zhou J, Zhao Y (2013) The comparison of 2 microns laser five points method vaporization resection and plasma bipolar electrotomy for curative effect of high-risk prostatic hyperplasia. China J Endosc 2:155–157

21.

Peng B, Wang GC, Zheng JH, Xia SQ, Geng J, Che JP, Yan Y, Huang JH, Xu YF, Yang B (2013) A comparative study of thulium laser resection of the prostate and bipolar transurethral plasmakinetic prostatectomy for treating benign prostatic hyperplasia. BJU Int 111(4):633–637. https://doi.org/10.1111/j.1464-410X.2012.11610.x CrossRefPubMed

22.

Peng M, Yi L, Wang Y (2016) Photoselective vaporization of the prostate vs plasmakinetic resection of the prostate: a randomized prospective trial with 12-month follow-up in Mainland China. Urology 87:161–165. https://doi.org/10.1016/j.urology.2014.08.038 CrossRefPubMed

23.

Sun Y, Luo G, Sun Z, Liu J, Wang Y, Yang X, Zhu J (2011) A comparative study on the results of two micron laser vaporesection of prostate and bipolar transurethral plasmakinetic prostatectomy for benign prostatic hyperplasia. China J Endosc 7:687–691

24.

Wei H, Shao Y, Sun F, Sun X, Zhuo J, Zhao F, Han B, Jiang J, Chen H, Xia S (2014) Thulium laser resection versus plasmakinetic resection of prostates larger than 80 ml. World J Urol 32(4):1077–1085. https://doi.org/10.1007/s00345-013-1210-4 CrossRefPubMed

25.

Wu G, Hong Z, Li C, Bian C, Huang S, Wu D (2016) A comparative study of diode laser and plasmakinetic in transurethral enucleation of the prostate for treating large volume benign prostatic hyperplasia: a randomized clinical trial with 12-month follow-up. Lasers Med Sci 31(4):599–604. https://doi.org/10.1007/s10103-016-1883-1 CrossRefPubMed

26.

Xu A, Zou Y, Li B, Liu C, Zheng S, Li H, Xu Y, Chen B, Xu K, Shen H (2013) A randomized trial comparing diode laser enucleation of the prostate with plasmakinetic enucleation and resection of the prostate for the treatment of benign prostatic hyperplasia. J Endourol 27(10):1254–1260. https://doi.org/10.1089/end.2013.0107 CrossRefPubMed

27.

Yang Z, Liu T, Wang X (2016) Comparison of thulium laser enucleation and plasmakinetic resection of the prostate in a randomized prospective trial with 5-year follow-up. Lasers Med Sci 31(9):1797–1802. https://doi.org/10.1007/s10103-016-2052-2 CrossRefPubMed

28.

Yang Z, Wang X, Liu T (2013) Thulium laser enucleation versus plasmakinetic resection of the prostate: a randomized prospective trial with 18-month follow-up. Urology 81(2):396–400. https://doi.org/10.1016/j.urology.2012.08.069 CrossRefPubMed

29.

Lnog Z, Wang G, He L, Zhong K, Zhang Y, Pei X, Peng D (2012) Clinical study of efficacy and safety of transurethral photoselective laser vaporization for benign prostatic hyperplasia. China J Endosc 1:9–13

30.

Bozzini G, Seveso M, Melegari S, de Francesco O, Buffi NM, Guazzoni G, Provenzano M, Mandressi A, Taverna G (2017) Thulium laser enucleation (ThuLEP) versus transurethral resection of the prostate in saline (TURis): a randomized prospective trial to compare intra and early postoperative outcomes. Actas Urol Espanol 41(5):309–315. https://doi.org/10.1016/j.acuro.2016.06.010 CrossRef

31.

Skinner TAA, Leslie RJ, Steele SS, Nickel JC (2017) Randomized, controlled trial of laser vs. bipolar plasma vaporization treatment of benign prostatic hyperplasia. Can Urol Assoc J 11(6):194–198. https://doi.org/10.5489/cuaj.4213

32.

Zou Z, Xu A, Zheng S, Chen B, Xu Y, Li H, Duan C, Zheng J, Chen J, Li C, Wang Y, Gao Y, Liang C, Liu C (2018) Dual-centre randomized-controlled trial comparing transurethral endoscopic enucleation of the prostate using diode laser vs. bipolar plasmakinetic for the treatment of LUTS secondary of benign prostate obstruction: 1-year follow-up results. World J Urol 36(7):1117–1126. https://doi.org/10.1007/s00345-018-2229-3

33.

Cai F, Chen C, Zhnag J (2015) Application of Clavien-Dindo classification for comparing complications of three endoscopic procedures for benign prostatic hyperplasia. J Southern Med Univ 35(9):1344–1348

34.

Chen Y, Xu H, Xu H, Gu M, Zhou J, Cai Z, Wang Z, Chen Q (2016) Comparison of plasmakinetic enucleation of the prostate with holmium laser enucleation of the prostate in the treatment of benign prostate hyperplasia. Int J Clin Exp Med 9(4):7328–7333

35.

Wang Z, Chen Y, Chen Q, Cai Z, Yao H, Zheng D, Zhou J, Peng Y (2014) Comparative study of the safety and efficacy between the plasma kinetic resection of the prostate and holmium laser enucleation of the prostate in the treatment of BPH. Chinese J Urol 5:349–353

36.

Zhu QY, Gu XJ, Yuan L, Huang WZ, Zhang L, Lu ZJ, Zhang P, Su J, Xu Y, Zhang Y (2008) TUBVP and HOLEP: desirable surgical options for large benign prostatic hyperplasia ( %3e 80 ml). Nat J Androl 14(10):907–910

37.

Kim JW, Kim YJ, Lee YH, Kwon JB, Cho SR, Kim JS (2014) An analytical comparison of short-term effectiveness and safety between thulium:YAG laser vaporesection of the prostate and bipolar transurethral resection of the prostate in patients with benign prostatic hyperplasia. Korean J Urol 55(1):41–46. https://doi.org/10.4111/kju.2014.55.1.41 CrossRefPubMedPubMedCentral

38.

Liu C, Li N, Liu Y, Wang P (2011) Thulium laser vaporesection of prostate versus transurethral plasmakinetic resection of prostate for BPH patients. Chinese J Laser Med Surg 2:102–105

39.

Chen G, Li Z, Zhang X (2017) Comparative study between holmium laser enucleation and transurethral Plasma kinetic enucleation for benign prostatic hyperplasia. Chin J Minim Invasive Surg 17:803–807

40.

Cimino S, Voce S, Palmieri F, Favilla V, Castelli T, Privitera S, Giardina R, Reale G, Russo GI, Morgia G (2017) Transurethral resection of the prostate (TURP) vs GreenLight photoselective vaporization of benign prostatic hyperplasia: analysis of BPH6 outcomes after 1 year of follow-up. I J Impot Res 29(6):240–243. https://doi.org/10.1038/ijir.2017.30 CrossRef

41.

Mu XN, Wang SJ, Chen J, Jin XB, Huang ZX, Zhang LY (2017) Bipolar transurethral enucleation of prostate versus photoselective vaporization for symptomatic benign prostatic hyperplasia (%3e70 ml). Asian J Androl 19(5):608–612. https://doi.org/10.4103/1008-682x.178484 CrossRefPubMed

42.

Wang SJ, Mu XN, Chen J, Jin XB, Zhang SB, Zhang LY (2017) Plasmakinetic enucleation of prostate versus 160-W laser photoselective vaporization for the treatment of benign prostatic hyperplasia. Asian J Androl 19(1):15–19. https://doi.org/10.4103/1008-682x.164199 CrossRefPubMed

43.

Li S, Kwong JS, Zeng XT, Ruan XL, Liu TZ, Weng H, Guo Y, Xu C, Yan JZ, Meng XY, Wang XH (2015) Plasmakinetic resection technology for the treatment of benign prostatic hyperplasia: evidence from a systematic review and meta-analysis. Sci Rep 5:12002. https://doi.org/10.1038/srep12002 CrossRefPubMedPubMedCentral

44.

Naspro R, Gomez Sancha F, Manica M, Meneghini A, Ahyai S, Aho T, Fiori C, Vavassori I, Pansadoro LF, Montorsi V, Herrmann F (2017) From "gold standard" resection to reproducible "future standard" endoscopic enucleation of the prostate: what we know about anatomical enucleation. Italian J Urol Nephrol 69(5):446–458. https://doi.org/10.23736/s0393-2249.17.02834-x CrossRef

45.

Guo Q, Xiao Y, Li JW, Zhang JD, Zhang YG (2016) Safety and effect of transurethral holmium laser enucleation of the prostate versus bipolar transurethral plasmakinetic prostatectomy for benign prostatic hyperplasia: A meta-analysis. Nat J Androl 22(10):914–922

46.

Qian X, Liu H, Xu D, Xu L, Huang F, He W, Qi J, Zhu Y, Xu D (2017) 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 20(3):184–191. https://doi.org/10.1080/13685538.2017.1295436 CrossRefPubMed

Title: Lasers versus bipolar technology in the transurethral treatment of benign prostatic enlargement: a systematic review and meta-analysis of comparative studies
Authors: Chaohui Gu
Naichun Zhou
Pratik Gurung
Yiping Kou
Yang Luo
Yidi Wang
Hui Zhou
Cheng Zhen
Jinjian Yang
Fengyan Tian
Guan Wu
Publication date: 01-04-2020
Publisher: Springer Berlin Heidelberg
Keywords: Diode Laser
Urethral Stricture
Transurethral Prostate Resection
Laser
Published in: World Journal of Urology / Issue 4/2020
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-019-02852-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Lasers versus bipolar technology in the transurethral treatment of benign prostatic enlargement: a systematic review and meta-analysis of comparative studies

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2020

3D imaging applications for robotic urologic surgery: an ESUT YAUWP review

Electroacupuncture for women with urgency-predominant mixed urinary incontinence: secondary analysis of a randomized noninferiority trial

Comparative evaluation of tissue damage induced by ultrasound and impact dual-mode endoscopic lithotripsy versus conventional single-mode ultrasound lithotripsy

Robotic surgery in urology: the way forward

EMS Lithoclast Trilogy™: an effective single-probe dual-energy lithotripter for mini and standard PCNL

Letter to editor for the article “The effect of short-term preoperative ureteral stenting on the outcomes of retrograde intrarenal surgery for renal stones”