A Systematic Review Of The Thulium Laser Resection Of The Prostate VS Transurethral Resection Of The Prostate

Background : Benign prostatic hyperplasia(BPH)is one of the most common diseases in middle-aged and elderly men,and is one of the most common causes of lower urinary tract symptoms(LUTS).LUTS cause discomfort,and often have a significant impact on the quality of life(QoL)of patients.Approximately 50–60% of men aged >60 years suffer from BPH and the associated LUTS.Surgical removal is an appropriate treatment option for patients with moderate to severe LUTS.Although traditional transurethral resection of the prostate(TURP)has been considered as the standard surgical procedure for patients with BPH for decades,it has been associated with the development of significant complications.With the development of new scientific and technological methods,more advanced surgical tech-niques are now being employed in BPH treatment.The thulium laser resection of the prostate(TMLRP)technique is a relatively new approach,and was first reported in 2005.TMLRP is one such procedure;it can be performed with normal saline(NaCl 0.9%)irrigation and overcomes a fundamental disadvantage of TURP,which ensures that surgeons have more time to safely resect larger prostates。In TMLRP,a wavelength of approximately 2 μm is emitted in continuous-wave mode,thus enabling the precise incision of tissue by using a wavelength that matches the water absorption peak of 1.92 μm in tissue.Thus,the procedure ensures more effective resection and vaporization of prostate tissue.In addition,because TMLRP achieves excellent urine clarity after surgery,patients do not require bladder irrigation.Furthermore,the risk of TUR syndrome is decreased because TMLRP involves the use of physiologic saline as the irrigation fluid.Objective: Benign prostatic hyperplasia(BPH)is one of the most common diseases in middle-aged and elderly men.In the present study,weaimed to compare the efficacy and safety of 2μm laser resection of the prostate(TMLRP)with transurethral resection of the prostate(TURP).Methods: A literature search was performed from 6 main database.Searches were applied to following electronic database: 1.Pubmed(1995-2015.12)2.ovid(1995-2015.12)3.Cochranelibrary(1995-2015.12)4.WANFANG DATA(1995-2015.12)5.CNKI(1995-2015.12)6.CQVIP(1995-2015.12).We used the terms: Hyperplasia,Prostatic Prostatic Hypertrophy Adenoma,Prostatic Adenomas,Prostatic Prostatic Adenomas Prostatic Adenoma Benign Prostatic Hyperplasia Prostatic Hyperplasia,Benign Prostatic Hypertrophy,Benign Benign Prostatic Hypertrophy Hypertrophy,Prostate Transurethral Resection Prostate Transurethral Resections Transurethral Prostate Resection Prostate Resection,Transurethral Prostate Resections,Transurethral Resection,Transurethral Prostate Resections,Transurethral Prostate Transurethral Prostate Resections TURP TURPs Prostatectomy,Transurethral Prostatectomies,Transurethral Transurethral Prostatectomies Transurethral ProstatectomyEventually 2μm2-μm 2micron and so on.8 studies involving 789 patients were included in our study.The quality of 4 randomized controlled trials(RCTs)was assessed using the tool of “risk of bias”,according to the Cochrane Handbook Random sequence generation,allocation concealment,blinding,incomplete data,and selective reporting were assessed.Each of them was graded as “yes,” “no,” or“unclear,” which reflected low risk of bias,high risk of bias,and uncertain of bias,respectively.The meth-odological quality of non-RCTs was assessed with the Newcastle–Ottawa Scale,which is a “star system” con-taining eight items,categorized into three broad perspec-tives: the selection of the study groups,the comparability of the groups,and the ascertainment of the outcome.The Newcastle–Ottawa Scale ranges between zero and nine stars.5-9scores neans a hight quality of the trialForest plots were produced by using Revman5.3.0 software.α=0.05.Results: We included 4 RCTs and 4CCTs,for a total of 798 patient s(experment group 406,control group 383).Our meta-analysis showed that TMLRP have a longer operation tim e[MD(mean difference)=15min,95%CI(confidence interval)8.69-21.31,P<0.00001],but shorter time of hospital stay and catheterization time.In the factors of decrease in hemoglobin level,transitory urge incontinence rat e,the retrograde ejaculation rate and dysuresia did not significantly diffe r between TMLRP and TURP.Development of urethral stricture[MD=0.38,95%CI 0.14-1.0,P=0.05] and blood transfusion rate[MD=0.25,95%CI 0.09-0.69,P=0.008] significantly differed between TMLRP and TURP.At 3,6,and 12 months of postoperative follow-up,the maximum flow rate,quality of life did not significantly differ among the procedures.TMLRP had a better performance in International Prostate Symptom Score at 6[MD=1.22,95%CI 0.10-2.34,P=0.03] and 12 months of postoperative foll ow-up[MD=1.95,95%CI 0.63-3.27,P=0.004].Conclusions: TMLRP have a longer operation time,but shorter time of hospital stay and catheterization time.TMLRP offered several advantages over TURP in term of urethral stricture and blood transfusion rate.And in International Prostate Symptom Score,TURP and post-void residual maybe better.Well-designed multicentric RCTs with long-term follow-up are still needed.