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Holmium Laser Enucleation versus Transurethral Resection in Patients with Benign Prostate Hyperplasia: An Updated Systematic Review with Meta-Analysis and Trial Sequential Analysis

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  • Sheng Li
  • Xian-Tao Zeng
  • Xiao-Lan Ruan
  • Hong Weng
  • Tong-Zu Liu
  • Xiao Wang
  • Chao Zhang
  • Zhe Meng
  • Xing-Huan Wang

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.

Suggested Citation

  • Sheng Li & Xian-Tao Zeng & Xiao-Lan Ruan & Hong Weng & Tong-Zu Liu & Xiao Wang & Chao Zhang & Zhe Meng & Xing-Huan Wang, 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, Public Library of Science, vol. 9(7), pages 1-14, July.
    • Handle: RePEc:plo:pone00:0101615
    DOI: 10.1371/journal.pone.0101615
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    References listed on IDEAS

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    1. Kristian Thorlund & Georgina Imberger & Michael Walsh & Rong Chu & Christian Gluud & Jørn Wetterslev & Gordon Guyatt & Philip J Devereaux & Lehana Thabane, 2011. "The Number of Patients and Events Required to Limit the Risk of Overestimation of Intervention Effects in Meta-Analysis—A Simulation Study," PLOS ONE, Public Library of Science, vol. 6(10), pages 1-10, October.
    2. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    3. Sung Han Kim & Changwon Yoo & Minsoo Choo & Jae-Seung Paick & Seung-June Oh, 2014. "Factors Affecting De Novo Urinary Retention after Holmium Laser Enucleation of the Prostate," PLOS ONE, Public Library of Science, vol. 9(1), pages 1-5, January.
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