Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2014 Jul 8;9(7):e101615.
doi: 10.1371/journal.pone.0101615. eCollection 2014.

Holmium laser enucleation versus transurethral resection in patients with benign prostate hyperplasia: an updated systematic review with meta-analysis and trial sequential analysis

Sheng Li  1 , Xian-Tao Zeng  2 , Xiao-Lan Ruan  3 , Hong Weng  2 , Tong-Zu Liu  1 , Xiao Wang  1 , Chao Zhang  2 , Zhe Meng  1 , Xing-Huan Wang  1
Affiliations
Meta-Analysis

Holmium laser enucleation versus transurethral resection in patients with benign prostate hyperplasia: an updated systematic review with meta-analysis and trial sequential analysis

Sheng Li et al. PLoS One. .

Abstract

Background: Holmium laser enucleation (HoLEP) in surgical treatment of benign prostate hyperplasia (BPH) potentially offers advantages over transurethral resection of the prostate (TURP).

Methods: Published randomized controlled trials (RCTs) were identified from PubMed, EMBASE, Science Citation Index, and the Cochrane Library up to October 10, 2013 (updated on February 5, 2014). After methodological quality assessment and data extraction, meta-analysis was performed using STATA 12.0 and Trial Sequential Analysis (TSA) 0.9 software.

Results: Fifteen studies including 8 RCTs involving 855 patients met the criteria. The results of meta-analysis showed that: a) efficacy indicators: there was no significant difference in quality of life between the two groups (P>0.05), but compared with the TURP group, Qmax was better at 3 months and 12 months, PVR was less at 6, 12 months, and IPSS was lower at 12 months in the HoLEP, b) safety indicators: compared with the TURP, HoLEP had less blood transfusion (RR 0.17, 95% CI 0.06 to 0.47), but there was no significant difference in early and late postoperative complications (P>0.05), and c) perioperative indicators: HoLEP was associated with longer operation time (WMD 14.19 min, 95% CI 6.30 to 22.08 min), shorter catheterization time (WMD -19.97 h, 95% CI -24.24 to -15.70 h) and hospital stay (WMD -25.25 h, 95% CI -29.81 to -20.68 h).

Conclusions: In conventional meta-analyses, there is no clinically relevant difference in early and late postoperative complications between the two techniques, but HoLEP is preferable due to advantage in the curative effect, less blood transfusion rate, shorter catheterization duration time and hospital stay. However, trial sequential analysis does not allow us to draw any solid conclusion in overall clinical benefit comparison between the two approaches. Further large, well-designed, multicentre/international RCTs with long-term data and the comparison between the two approaches remain open.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Identification of eligible studies.
Figure 2
Figure 2. Forest plot for International Prostate Symptom Score (IPSS) at 3 months, 6 months, and 12 months based on a random effects model.
WMD = weight mean difference; CI = confidence interval.
Figure 3
Figure 3. Forest plot for maximum flow rate (Qmax) at 3 months, 6 months, and 12 months based on a fixed effects model.
WMD = weight mean difference; CI = confidence interval.
Figure 4
Figure 4. Forest plot for postvoid residual volume (PVR) at 6 months and 12 months based on a random effects model.
WMD = weight mean difference; CI = confidence interval.
Figure 5
Figure 5. Forest plot for intraoperative complications.
RR = relative risk; CI = confidence interval.
Figure 6
Figure 6. Forest plot for early postoperative complications.
RR = relative risk; CI = confidence interval.
Figure 7
Figure 7. Forest plot for late postoperative complications.
RR = relative risk; CI = confidence interval.
Figure 8
Figure 8. Forest plot for perioperative indicators.
WMD = weight mean difference; CI = confidence interval.
Figure 9
Figure 9. Trial sequential analysis of operation time.
The required information size for operation time was calculated based on a two side α = 5%, β = 20% (power 80%), a minimal relevant difference of 5.0 min, a standard deviation of 29.2 min, and D2 = 63% as estimated in a random effects model.
Figure 10
Figure 10. Trial sequential analysis of catheterization time.
The required information size for operation time was calculated based on a two side α = 5%, β = 20% (power 80%), a minimal relevant difference of 5.0 min, a standard deviation of 26.8 min, and D2 = 60% as estimated in a random effects model.
Figure 11
Figure 11. Trial sequential analysis of hospital stay.
The required information size for operation time was calculated based on a two side α = 5%, β = 20% (power 80%), a minimal relevant difference of 5.0 min, a standard deviation of 34.1 min, and D2 = 54% as estimated in a random effects model.
See this image and copyright information in PMC

References

    1. McVary KT, Roehrborn CG, Avins AL, Barry MJ, Bruskewitz RC, et al. (2011) Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol 185: 1793–1803. - PubMed
    1. Oelke M, Bachmann A, Descazeaud A, Emberton M, Gravas S, et al. (2013) EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 64: 118–140. - PubMed
    1. Gilling P, Fraundorfer M, Kabalin J (1997) Holmium: YAG laser resection of the prostate (HoLRP) versus transurethral electrocautery resection of the prostate (TURP): a prospective randomized, urodynamics-based clinical trial. J Urol 157: 149A.
    1. Gilling PJ, Aho TF, Frampton CM, King CJ, Fraundorfer MR (2008) Holmium laser enucleation of the prostate: results at 6 years. Eur Urol 53: 744–749. - PubMed
    1. Kabalin JN, Mackey MJ, Cresswell MD, Fraundorfer MR, Gilling PJ (1997) Holmium: YAG laser resection of prostate (HoLRP) for patients in urinary retention. J Endourol 11: 291–293. - PubMed