Meta-analysis of efficacy and safety of holmium laser enucleation of the prostate and transurethral resection of the prostate in treatment of benign prostatic hyperplasia
-
摘要: 目的:系统评价钬激光前列腺剜除术(HoLEP)和经尿道前列腺电切术(TURP)治疗良性前列腺增生(BPH)的疗效和安全性。方法:计算机检索PubMed、Embase、The Cochrane Library和Web of Science收集比较HoLEP和TURP治疗BPH的随机对照试验(RCT),检索时限均从建库至2020年6月。由两位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果:共纳入12项研究,包括1378例患者,其中HoLEP组691例,TURP组687例。Meta分析结果显示,HoLEP组留置导尿时间[MD=-0.80,95%CI(-1.02,-0.58),P<0.000 01]、住院时间[MD=-1.07,95%CI(-1.35,-0.80),P<0.000 01]、血红蛋白下降程度[MD=-0.39,95%CI(-0.60,-0.17),P=0.000 4]、输血率[RR=0.19,95%CI(0.08,0.44),P=0.000 1]及尿道狭窄发生率[RR=0.48,95%CI(0.26,0.90),P=0.02]低于TURP组;术后12个月及36个月的美国泌尿外科协会前列腺症状评分(AUA-SS)[MD=-0.99,95%CI(-1.59,-0.40),P=0.001;MD=-0.08,95%CI(-0.12,-0.04),P=0.000 2]、术后12个月及24个月的最大尿流率(Qmax)[MD=0.88,95%CI(0.27,1.49),P=0.005;MD=1.00,95%CI(0.38,1.61),P=0.002]、术后12个月的残余尿(PVR)[MD=-8.95,95%CI(-16.45,-1.45),P=0.02]优于TURP组,但手术时间[MD=16.48,95%CI(11.08,21.89),P<0.000 01]高于TURP组。结论:与TURP相比,HoLEP留置导尿时间及住院时间短,安全性高,术后短期及中期随访疗效更佳,输血率及尿道狭窄发生率更低,因此HoLEP治疗BPH具有更好的疗效及安全性。Abstract: Objective: To systematically review the efficacy and safety of holmium laser enucleation of the prostate(HoLEP) and transurethral resection of the prostate(TURP) for benign prostatic hyperplasia(BPH).Methods: We searched PubMed, Embase, The Cochrane Library and Web of Science from inception to June 2020 to collect the randomized controlled trials(RCTs). Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. RevMan 5.3 software was used for Meta-analysis.Results: A total of 12 studies were included, involving 1378 patients, 691 patients in HoLEP group and 687 patients in TURP group. The Meta-analysis showed that the catheter indwelling time [MD=-0.80, 95%CI(-1.02,-0.58), P<0.000 01], hospital stay [MD=-1.07, 95%CI(-1.35,-0.80), P<0.000 01], hemoglobin loss [MD=-0.39, 95%CI(-0.60,-0.17), P=0.000 4], transfusion rate [RR=0.19, 95%CI(0.08, 0.44), P=0.000 1], and incidence of urethral stricture [RR=0.48, 95%CI(0.26, 0.90), P=0.02] in the HoLEP group were lower than those in the TURP group. And the AUA-SS at 12 months and 36 months postoperatively [MD=-0.99, 95%CI(-1.59,-0.40), P=0.001; MD=-0.08, 95%CI(-0.12,-0.04), P=0.000 2], the Qmax at 12 months and 24 months postoperatively [MD=0.88, 95%CI(0.27, 1.49), P=0.005; MD=1.00, 95%CI(0.38, 1.61), P=0.002]and the PVR at 12 months postoperatively [MD=-8.95, 95%CI(-16.45,-1.45), P=0.02] in the HoLEP group were superior to the TURP group. However, HoLEP group had longer operation time [MD=16.48, 95%CI(11.08, 21.89), P<0.000 01].Conclusion: Compared with TURP treatment, HoLEP has shorter catheter indwelling time and hospital stay, higher safety, better results in short-term and mid-term follow-up after surgery, and lower postoperative blood transfusion rate and incidence of urethral stricture. Therefore, HoLEP has better efficacy and safety in the treatment of BPH.
-
-
[1] Gratzke C,Bachmann A,Descazeaud A,et al.EAUGuidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction[J].Eur Urol,2015,67(6):1099-1109.
[2] Reich O,Gratzke C,Bachmann A,et al.Morbidity,mortality and early outcome of transurethral resection of the prostate:aprospective multicenter evaluation of10,654patients[J].J Urol,2008,180(1):246-249.
[3] Wei JT,Calhoun E,Jacobsen SJ.Urologic diseases in america project:benign prostatic hyperplasia[J].JUrol,2008,179(5Suppl):S75-80.
[4] European Association of Urology.EAU guidelines on management of non-neurogenic male lower urinary tract symptoms(LUTS),incl.Benign Prostatic Obstruction(BPO)[M].Netherlands:European Association of Urology Guidelines Office,2020.
[5] Bach T,Muschter R,Sroka R,et al.Laser treatment of benign prostatic obstruction:basics and physical differences[J].Eur Urol,2012,61(2):317-325.
[6] Ahyai SA,Lehrich K,Kuntz RM.Holmium laser enucleation versus transurethral resection of the prostate:3-year follow-up results of a randomized clinical trial[J].Eur Urol,2007,52(5):1456-1463.
[7] Basic D,Stankovic J,Potic M,et al.Holmium laser enucleation versus transurethral resection of the prostate:a comparison of clinical results[J].Acta Chir Iugosl,2013,60(1):15-20.
[8] Eltabey MA,Sherif H,Hussein AA.Holmium laser enucleation versus transurethral resection of the prostate[J].Can J Urol,2010,17(6):5447-5452.
[9] Fayad AS,Elsheikh MG,Zakaria T,et al.Holmium Laser Enucleation of the Prostate Versus Bipolar Resection of the Prostate:A Prospective Randomized Study."Pros and Cons"[J].Urology,2015,86(5):1037-1041.
[10] Gilling PJ,Wilson LC,King CJ,et al.Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate:results at 7years[J].BJU Int,2012,109(3):408-411.
[11] Gu M,Chen YB,Liu C,et al.Comparison of Holmium Laser Enucleation and Plasmakinetic Resection of Prostate:A Randomized Trial with 72-Month FollowUp[J].J Endourol,2018,32(2):139-143.
[12] Gupta N,Sivaramakrishna,Kumar R,et al.Comparison of standard transurethral resection,transurethral vapour resection and holmium laser enucleation of the prostate for managing benign prostatic hyperplasia of>40g[J].BJU Int,2006,97(1):85-89.
[13] Hamouda A,Morsi G,Habib E,et al.A comparative study between holmium laser enucleation of the prostate and transurethral resection of the prostate:12-month follow-up[J].J Clin Urol,2016,7(2):99-104
[14] Jhanwar A,Sinha RJ,Bansal A,et al.Outcomes of transurethral resection and holmium laser enucleation in more than 60g of prostate:A prospective randomized study[J].Urol Ann,2017,9(1):45-50.
[15] Mavuduru RM,Mandal AK,Singh SK,et al.Comparison of HoLEP and TURP in terms of efficacy in the early postoperative period and perioperative morbidity[J].Urol Int,2009,82(2):130-135.
[16] Rigatti L,Naspro R,Salonia A,et al.Urodynamics after TURP and HoLEP in urodynamically obstructed patients:are there any differences at 1year of followup?[J].Urology,2006,67(6):1193-1198.
[17] Sun N,Fu Y,Tian T,et al.Holmium laser enucleation of the prostate versus transurethral resection of the prostate:a randomized clinical trial[J].Int Urol Nephrol,2014,46(7):1277-1282.
[18] 肖遥,郝斌,许长宝,等.钬激光剜除术治疗良性前列腺增生疗效的荟萃分析[J].临床泌尿外科杂志,2018,33(11):887-893.
[19] Zhong J,Feng Z,Peng Y,et al.A Systematic Review and Meta-analysis of Efficacy and Safety Following Holmium Laser Enucleation of Prostate and Transurethral Resection of Prostate for Benign Prostatic Hyperplasia[J].Urology,2019,131:14-20.
[20] Ahyai SA,Chun FK,Lehrich K,et al.Transurethral holmium laser enucleation versus transurethral resection of the prostate and simple open prostatectomy--which procedure is faster?[J].J Urol,2012,187(5):1608-1613.
[21] Kim SC,Matlaga BR,Kuo RL,et al.Holmium laser enucleation of the prostate:a comparison of efficiency measures at two institutions[J].J Endourol,2005,19(5):555-558.
[22] Shah HN,Mahajan AP,Sodha HS,et al.Prospective evaluation of the learning curve for holmium laser enucleation of the prostate[J].J Urol,2007,177(4):1468-1474.
[23] Aho T,Armitage J,Kastner C.Anatomical endoscopic enucleation of the prostate:The next gold standard?Yes![J].Andrologia,2020,52(8):e13643.
[24] Gravas S,Bachmann A,Reich O,et al.Critical review of lasers in benign prostatic hyperplasia(BPH)[J].BJU Int,2011,107(7):1030-1043.
[25] Rieken M,Bachmann A.Laser treatment of benign prostate enlargement--which laser for which prostate?[J].Nat Rev Urol,2014,11(3):142-152.
[26] Abdul-Muhsin H,Critchlow W,Navaratnam A,et al.Feasibility of holmium laser enucleation of the prostate as a 1-day surgery[J].World J Urol,2020,38(4):1017-1025.
[27] Lwin AA,Zeng J,Evans P,et al.Holmium Laser Enucleation of the Prostate Is Safe and Feasible as a Same Day Surgery[J].Urology,2020,138:119-124.
[28] Sun J,Tong Z,Shi A,et al.Comparison Between 1-Day and Inpatient Procedure of Holmium Laser Enucleation in Patients With Benign Prostate Hyperplasia[J].Am J Mens Health,2019,13 (6):1557988319894480.
[29] Kuntz RM,Lehrich K.Transurethral holmium laser enucleation versus transvesical open enucleation for prostate adenoma greater than 100gr:A randomized prospective trial of 120patients[J].J Urol,2002,168(4Pt 1):1465-1469.
[30] Oh JK,Ko KP,Oh SJ.Measuring change in prostate size after holmium laser enucleation:A prospective study[J].Investig Clin Urol,2017,58(3):200-204.
[31] 杜传军,白福鼎,陈继民,等.前列腺钬激光剜出术与电切术安全性及疗效比较[J].中华泌尿外科杂志,2004,25(9):627-630.
[32] Fayad AS,Sheikh MG,Zakaria T,et al.Holmium laser enucleation versus bipolar resection of the prostate:a prospective randomized study.Which to choose?[J].JEndourol,2011,25(8):1347-1352.
[33] Briganti A,Naspro R,Gallina A,et al.Impact on sexual function of holmium laser enucleation versus transurethral resection of the prostate:results of a prospective,2-center,randomized trial[J].J Urol,2006,175(5):1817-1821.
-
计量
- 文章访问数: 477
- PDF下载数: 85
- 施引文献: 0