Photoselective vaporisation & holmium laser enucleation of the prostate versus transurethral resection of the prostate due to benign prostatic hyperplasia: A systematic review and meta-analysis.

Abstract

Aim : LASERs are becoming an increasingly popular method for the surgical management of benign prostatic hyperplasia (BPH). The research relating to the use of photoselective vaporisation (PVP) has expanded rapidly. There is also evidence that eff ective outcomes can be reached with Holmium Eneucleation of the Prostate (HoLEP). Similarly, no reviews on the subject are yet to evaluate the diff erences between the 120 W lithium triborate (LBO) and 80 W potassium titanyl phosphate (KTP) systems. We conduct a systematic review and metaanalysis of these two popular laser systems, and explore whether any diff erences in outcomes between the two exist. Further sub-group analysis was conducted between the two methods of PVP (120 W and 80 W). Methods : P ublications between 2000 and 2012 in Medline, Embase, PubMed, Cochrane Central Register of Controlled Trials were identified, as well as those found by hand searching. The risk ratio and mean diff erence (as well as the 95% confidence intervals) for outcomes were calculated. Results : 1 5 trials with 2107 participants met the inclusion criteria with a mean follow up of 16 months. PVP and HoLEP provided similar functional outcomes (QMax and IPSS) as TURP, but have advantages in terms of hospital stay and haemostasis. Operating time with the 120 W is shorter than the 80 W laser; however the reoperation rate is higher. Conclusion(s): Th is is the largest analysis conducted to do date that reviews these two lasers. They off er advantages for patients in terms of convalescence and haemostasis, at the cost of increased operating time and in some instances reoperation.