The Efficacy And Safety Of Holmium Laser Enucleation Of The Prostate For Benign Prostate Hyperplasia: A Meta-analysis

Objective To systematically review and evaluate the efficacy andsafety of holmium laser enucleation of the prostate(HoLEP) for benignprostate hyperplasia.Methods To search PubMed, Ovid, Cochrane library, EMBASE，Wanfang，VIP，CNKI up to Jan2012. All randomized controlled trials（RCTs） comparing HoLEP and TURP were included. Two reviewsindependently extracted data which consistent with included standard andassessed quality. Meta–analysis was conducted with Rev Man5.0.Results We identified7RCTs with a total of630patients met theinclusion criteria. The meta-analysis showed that HoLEP was associatedwith significantly less hemoglobin los（sWMD-0.46，95%CI-0.81～-0.11；P=0.01<0.05）, a shorter hospital stay （WMD-26.20，95%CI-32.41～-20.09；P=0.001<0.05）and a shorter catheterization time（WMD-23.15，95%CI-29.09～-17.22；P<0.05）. Whereas, there was a shorter operatingtime in the TURP group （WMD17.25，95%CI8.47～26.03；P=0.0001<0.05）. There was no statistical difference in weight of resected gland（WMD-0.38，95%CI-12.45～11.69；P=0.95>0.05）. There was agreater improvement from baseline IPSS、Qmax in the HoLEP group（WMD-0.67，95%CI-1.25～-0.10；P=0.02<0.05; WMD1.46，95%CI0.99～1.93；P<0.00001）, but no statistically significant difference in QOLscore(WMD0.31，95%CI-0.17～0.80；P=0.21>0.05）. Blood transfusionrate was higher for TURP than HoLEP(OR0.24，95%CI0.07～0.85，P=0.03<0.05). The complications were similar in terms of urethralstricture(OR0.59,95%CI0.26～1.34; P=0.21>0.05), stressincontinence(OR1.14,95%CI0.40～3.19; P=0.81>0.05).Conclusion This meta-analysis demonstrates that HoLEP is a safeand highly effective technique for the surgical treatment of bladder outletobstruction due to BPH. HoLEP is more effective for postoperativesymptom-related outcomes in patients with symptomatic BPH. HoLEP isassociated with less blood loss, a shorter hospital stay, a shortercatheterization time and fewer requirement for blood transfusion.