Continence After Different Laser Surgery For Benign Prostatic Hyperplasia:A Network Meta-analysis

Background:Holmium laser,green laser,thulium laser and other technologies are increasingly used to treat lower urinary tract symptoms(LUTS)caused by benign prostatic hyperplasia(BPH).Compared with TURP,their safety and efficacy have been affirmed.Most of the researches on continence after laser treatment of BPH are direct comparison studies between a single laser technique and TURP or PKRP,lack of research information that directly compares three laser techniques to treat BPH.Objective:Using the method of evidence-based medicine,combined with relevant statistical knowledge,a network meta-analysis of the current published original research is made to compare the continence after using holmium laser,green laser,thulium laser and other related surgical methods in the treatment of BPH/LUTS.Methods:We searched PubMed,EMBASE and Cochrane library databases for randomized controlled trials(RCTs)of HoLEP,PVP,ThuLEP,TmLRP,ThuVEP compared with TURP and PKRP or with each other in the treatment of BPH/LUTS.From the establishment of each database to June 1,2020.Two researchers independently screened and extracted data according to the inclusion and exclusion criteria,and evaluated the quality of the included literatures.The outcomes of the study include International Symptom Score(IPSS),Maximum Urine Flow Rate(Qmax),Postvoid Residual Volume(PVR),Quality of Life Score(QoL)during 6-36 months after surgery,and complications include urethral stricture,bladder neck contracture,urinary tract infection,urinary retention,dysuria,urinary incontinence,urge incontinence,stress urinary incontinence.Use R language version 4.0.3 software to load gemtc and coda packages,and JAGS-4.3.0 software was used for statistical analysis.The mean difference(MD)and 95%confidence interval(CI)were used for the evaluation of the effect values of continuous variable indexes,while the Odds ratio(OR)and 95%confidence interval(CI)were selected for the evaluation of the effect values of the indicators of the second classification variables,the difference of operation methods was compared by the effect value.Surface under the cumulative ranking curve(SUCRA)was used to rank the efficacy of the included surgical methods.Results:Included 43 articles,including 37 RCTs and 5 laser procedures,namely Holmium laser enucleation of the prostate(HoLEP)and Photo-selective vaporization of the prostate(PVP),Transurethral thulium laser enucleation of the prostate(ThuLEP),Transurethral thulium laser enucleation of the prostate(ThuLEP),Thulium laser resection of the prostate(TmLRP),Transurethral thulium laser enucleation of the prostate,TmLRP(Thulium laser vaporesection of the prostate,ThuVEP),which a total of 4906 patients were selected.The results of network meta-analysis showed that:1.Results at 6 months after surgery:HoLEP is better than TURP,PKRP,and PVP in improving PVR 6 months after surgery,while TURP is better than PVP;In improving QoL at 6 months after surgery,TURP is better than HoLEP and ThuVEP,while ThuVEP is better than PVP and ThuLEP;in the results of IPSS and Qmax at 6 months after surgery,HoLEP,PVP,ThuLEP,TmLRP,ThuVEP,TURP,PKRP There was no statistically significant difference in the comparison results of the same procedures.SUCRA results suggest that HoLEP has the most advantage in improving the ranking of IPSS,Qmax,and PVR at 6 months after surgery,while TURP has the most advantage in improving the ranking of QoL at 6 months after surgery.2.Results at 12 months after surgery:HoLEP is better than TURP,PKRP,PVP,TmLRP in improving Qmax at 12 months after surgery,while PKRP is better than PVP;in terms of improving PVR at 12 months after surgery,HoLEP is better than TURP,PKRP,PVP,TmLRP,ThuLEP;In the results of IPSS and QoL at 12 months after surgery,there was no statistically significant difference in the results of HoLEP,PVP,ThuLEP,TmLRP,ThuVEP,TURP,PKRP and other surgical procedures.SUCRA results suggest that HoLEP has the most advantage in improving the ranking of IPSS,Qmax,and PVR at 12 months after surgery,while PKRP has the most advantage in improving the ranking of QoL at 12 months.3.Results at 24 and 36 months after surgery:There was no statistically significant difference in the results of the network meta-analysis of IPSS,Qmax,PVR,and QoL at 24 and 36 months postoperatively.The results of SUCRA suggest that HoLEP has the most advantage in improving the ranking of IPSS,Qmax,and PVR at 24 and 36 months after surgery;PKRP has the most advantage in improving the ranking of QoL at 24 and 36 months after surgery.4.Results of postoperative complications:HoLEP is lower than TURP and PVP in the risk of urinary tract infection;There was no significant difference in the risk of complications such as urethral stricture,bladder neck contracture,urinary retention,dysuria,urinary incontinence,stress urinary incontinence,and urgency incontinence in HoLEP,PVP,ThuLEP,TmLRP,Thu VEP,TURP and PKRP.Conclusion:HoLEP,PVP,TmLRP,ThuLEP,and ThuVEP have more advantages in improving PVR at 6 months and IPSS,Qmax,PVR at 12 months after surgery.HoLEP can be used as a better choice.