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Review
. 2022;75(2):153-161.
doi: 10.5173/ceju.2022.0104. Epub 2022 Jun 22.

Does power setting impact surgical outcomes of holmium laser enucleation of the prostate? A systematic review and meta-analysis

Giacomo Maria Pirola  1 , Daniele Castellani  2 , Martina Maggi  3 , Ee Jean Lim  4 , Vinson Wai Shun Chan  5 , Angelo Naselli  6 , Jeremy Yuen Chun Teoh  7 , Vineet Gauhar  8
Affiliations
Review

Does power setting impact surgical outcomes of holmium laser enucleation of the prostate? A systematic review and meta-analysis

Giacomo Maria Pirola et al. Cent European J Urol. 2022.

Abstract

Introduction: The aim of this article was to enumerate the differences in immediate and postoperative outcomes for holmium laser enucleation of the prostate (HoLEP) performed with low-power (LP) or high-power (HP) laser settings through a systematic review of comparative studies.

Material and methods: We performed a systematic literature review using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. Potential clinical differences among LP and HP HoLEP were determined using the PICOS (Patient Intervention Comparison Outcome Study type) model, where outcomes were surgical time, operative efficiency, postoperative catheterization time, length of hospital stay, blood transfusion, incontinence rate, maximum urinary flow rate (QMax) and International Prostatic Symptom score (IPSS). Retrospective, prospective nonrandomized, randomized studies, and meeting abstracts were considered.

Results: A total of five studies were included for meta-analysis. No significant differences between LP and HP HoLEP were evidenced in terms of intraoperative variables (surgical time, surgical efficiency); postoperative outcomes (length of stay, length of catheterization); postoperative complications; functional results (IPSS; Qmax). Urinary incontinence rate did not differ between the two groups (OR 0.95, 95% CI 0.362.47, p = 0.91).

Conclusions: The study shows equal outcomes in outcomes from HoLEP performed with LP or HP energy settings. Even if further comparative studies are still needed to increase the level of evidence, those results encourage a further clinical adoption of LP HoLEP.

Keywords: benign prostatic hyperplasia; high-power laser; holmium laser; low-power laser.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Identification of studies via databases and registers.
Figure 2
Figure 2
Risk of bias in non-randomized controlled trials (ROBINS-I). A. Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies. B. Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figure 3
Figure 3
Risk of bias in non-randomized controlled trials (ROBINS-I).
Figure 4
Figure 4
Meta-analysis forest plot. A. Surgical time (minutes); B. Surgical efficiency (grams/minute); C. Postoperative catheterization (hours).
Figure 5
Figure 5
Meta-analysis forest plot. A. Postoperative stay (hours); B. Re-catheterization rate; C. Blood transfusions rate.
Figure 6
Figure 6
Meta-analysis forest plot. A. QMax (milliliters/second); B. IPSS; C. Incontinence rate.
See this image and copyright information in PMC

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