Green Laser Photoselective Vaporization Of Prostate Versus Transurethral Bipolar Plasmakinetic Resection Of Prostate For The Treatment Of Benign Prostatic Hyperplasia

Objective To compare the clinical effects and safety between Transurethral bipolar plasmakinetic resection of prostate(TUPKRP) and High-power Green laser photoselective vaporization(PVP) in Benign Prostatic Hyperplasia(BPH)Methods 1.90 cases of BPH with at least one internal disease were divided into two groups:46 cases in TUPKRP group and 44 cases in PVP group.The clinical data of all the patients were collected and compared between the TUPKRP group and PVP group,including pre-operation and three months after operation international prostate symptom score(IPSS),quality of life(QOL),urine flow rate(Qmax),residual urine(RUV)as well as operational time,operative bleeding volume, time of indwelling catheter after operation, hospitalization time after operation and complications after operation.2.Datebases such as Pubmed,Cochrane library,CBM,Embase,Medline,CNKI,Wanfang and Weipu were searched from their establishment to collect the randomized controlled trials( RCTs) and non-RCTs about PVP vs TUPKRP for the treatment of BPH. After the study selection,assessment and data extraction were conducted by two reviewers independently,and meta-analysis were performed using the Rev-Man 5.3 software.Results 1.Two groups has significantly improved both in IPSS,QOL,Qmax and RUV.The two groups had no statistically significant difference in this index(P>0.05).However,there were significant difference between the two groups in the operative bleeding volume,time of indwelling catheter after operation and hospitalization time after operation.The data of the PVP group was better than that of TUPKRP group.Complications after operation showed no difference.However.the operation time of the PVP was longer than the TUPKRP.2.Seven studies involving 619 patients were included.The results of meta-analysis showed that:(1)safety indicator:compared with TUPKRP,PVP had less bleeding[WMD= 92.85,95% CI( 56.09,129.60)(P<0.0001)],shorter indwelling catheter time[SMD= 0.47,95% CI( 0.23,0.72)(P=0.0002)],shorter catheterization time[SMD = 3.44,95% CI( 1.73,5.15)( P<0.0001)] and shorter hospital stay [ WMD=1.76,95%CI(0.93,2.59)( P<0.0001)],but had longer operation time [WMD =-14.04,95%CI(-20.51,-7.58)( P<0.0001)]. However,there was no significant difference in urethral stricture and bladder spasm(P>0.05),(2) efficacy indicator:the IPSS,QOL,Qmax after 3 months had no significant difference between the two groups( P >0.05).Conclusion PVP shows similar effects on significant improvements in IPSS,QOL and Qmax to TUPKRP.However,PVP is superior to TUPKRP in intraoperative blood loss,time of indwelling catheter,time of bladder irrigation and hospital stay afteroperation.