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Gill BC, Miller LE, Bhattacharyya S, Cash H, Eure GR. Complications of GreenLight Laser vs Transurethral Resection of the Prostate for Treatment of Lower Urinary Tract Symptoms: Meta-analysis of Randomized Trials. Urology 2024; 184:259-265. [PMID: 38176618 DOI: 10.1016/j.urology.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/14/2023] [Accepted: 12/26/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE To compare perioperative outcomes and complications between GreenLight and transurethral resection of the prostate (TURP) for benign prostatic hyperplasia. METHODS A systematic review and random effects meta-analysis of randomized trials comparing GreenLight with TURP was completed. Primary outcomes included periprocedural milestones, 12 predefined complications, Clavien-Dindo class III-V complications, reoperations (all-cause), and a composite of reoperations and readmissions. Metaregression assessed the relationship between patient- and study-level factors with periprocedural outcomes and reoperation rates. RESULTS The review included 13 randomized trials with 1757 patients (839 GreenLight; 918 TURP). Procedure time was 10 minutes (95% CI: 5 to 15; P < .001) longer with GreenLight, while catheterization time (mean difference=-1.3days; 95% CI: -1.7 to -0.9; P<.001) and hospital stay (mean difference=-2.1days; 95% CI: -2.5 to -1.7; P<.001) were shorter. Bleeding-related complications, including clot retention (risk ratio [RR]=0.12; 95% CI: 0.05 to 0.32; P<.001) and transfusion (RR=0.26; 95% CI: 0.12 to 0.58; P = .001), as well as sexual dysfunction (RR=0.66; 95% CI: 0.45 to 0.98; P = .04), were less frequent with GreenLight. All other complications occurred at similar frequencies between groups. The risks of reoperation (RR: 1.17; 95% CI: 0.82 to 1.66; P = .38) and reoperation or readmission (RR: 1.05; 95% CI: 0.76 to 1.44; P = .79) did not differ. CONCLUSION GreenLight achieved shorter catheterization times and hospital stays with lower rates of sexual dysfunction and bleeding-related complications compared to TURP.
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Affiliation(s)
- Bradley C Gill
- Department of Urology, Cleveland Clinic Foundation, Cleveland, OH
| | | | | | - Hannes Cash
- Department of Urology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
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Liu S, Liu H, Yao H, Sun F, Wu J, Zhou Z. A systematic review and meta-analysis of efficacy and safety comparing greenlight laser vaporization with transurethral resection of the prostate for benign prostatic hyperplasia with prostate volume less than 80 ml. Lasers Med Sci 2023; 38:133. [PMID: 37289405 DOI: 10.1007/s10103-023-03794-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/22/2023] [Indexed: 06/09/2023]
Abstract
We conducted a meta-analysis to evaluate the efficacy and safety of photo selective vaporisation of the prostate (PVP) with the GreenLight Laser versus transurethral resection of the prostate (TURP) for the treatment of small-volume benign prostatic hyperplasia (BPH). As of July 2022, relevant literature in online databases such as Cochrane Library, PubMed, and Embase was searched, including studies published on or before that date, and there were 9 studies in total, including 5 RCTs and 4 non-RCTs. In total 1525 patients were included to compare the efficacy of PVP and TURP in treating BPH. The Cochrane Collaboration criteria were used to evaluate the risk of bias. The software was used for random effect meta-analysis with RevMan 5.3. Data extraction included: clinical baseline characteristics, perioperative parameters, complication rates, International Prostate Symptom Score (IPSS), prostate specific antigen (PSA), post-void residual urine (PVR), maximum flow rate (Qmax), and quality of life (QoL). The pooled analysis showed that PVP was associated with reduced blood loss, blood transfusion, clot retention, catheterization time, definitive catheter removal, and hospital stay, but was associated with longer operative time and more severe dysuria (all p < 0.05). The results of this meta-analysis show that PVP as a technique for the treatment of benign prostatic hyperplasia with a volume of less than 80 cc has similar efficacy to standard TURP in IPSS, PSA, PVR, Qmax and QoL, and is an effective alternative. It outperformed TURP in terms of blood transfusion, catheterization time and hospital stay, while TURP is superior to PVP in terms of operation time.
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Affiliation(s)
- Shangjing Liu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, NO. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China
| | - Hongquan Liu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, NO. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China
| | - Huibao Yao
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, NO. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China
| | - Fengze Sun
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, NO. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China
| | - Jitao Wu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, NO. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China.
| | - Zhongbao Zhou
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, No.119 South 4Th Ring West Road, Fengtai District, Beijing, 100070, China.
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Manfredi C, García-Gómez B, Arcaniolo D, García-Rojo E, Crocerossa F, Autorino R, Gratzke C, De Sio M, Romero-Otero J. Impact of Surgery for Benign Prostatic Hyperplasia on Sexual Function: A Systematic Review and Meta-analysis of Erectile Function and Ejaculatory Function. Eur Urol Focus 2022; 8:1711-1732. [PMID: 35803852 DOI: 10.1016/j.euf.2022.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/17/2022] [Indexed: 01/25/2023]
Abstract
CONTEXT Several sexual side effects, including erectile, ejaculatory, and orgasmic dysfunction, were reported with the majority of surgical procedures for benign prostatic obstruction (BPO). OBJECTIVE To systematically review current evidence regarding the impact of benign prostatic hyperplasia (BPH) surgery on sexual function. EVIDENCE ACQUISITION A comprehensive bibliographic search on the MEDLINE, Cochrane Library, Embase, Web of Science, and Google Scholar databases was conducted in July 2021. The population, intervention, comparator, and outcome (PICO) model was used to define study eligibility. Studies were Included if they assessed patients with BPO and related lower urinary tract symptoms (P) undergoing BPH surgery (I) with or without a comparison between surgical treatments (C) evaluating the impact on sexual function (O). Retrospective and prospective primary studies were included. A pooled analysis was conducted on studies including the postoperative assessment of International Index of Erectile Function (IIEF)-5, Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD; Function and/or Bother), or retrograde ejaculation (RE) rate (PROSPERO database ID: CRD42020177907). EVIDENCE SYNTHESIS A total of 151 studies investigating 20 531 patients were included. Forty-eight randomized controlled trials evaluating 5045 individuals were eligible for the meta-analysis. In most studies (122, 80.8%), only erectile and/or ejaculatory function was evaluated. A substantial number of articles (67, 44.4%) also used nonvalidated tools to evaluate erectile and/or ejaculatory function. The pooled analysis showed no statistically significant changes in IIEF-5 score compared with baseline for the transurethral resection of the prostate (TURP; weighted mean difference [WMD] 0.76 pts; 95% confidence interval [CI] -0.1, 1.62; p = 0.08), laser procedure (WMD 0.33 pts; 95% CI -0.1, 0.77; p = 0.13), and minimally invasive treatment (WMD -1.37 pts; 95% CI -3.19, 0.44; p = 0.14) groups. A statistically significantly higher rate of RE was found after TURP (risk ratio [RR] 13.31; 95% CI 8.37, 21.17; p < 0.00001), other electrosurgical procedures (RR 34.77; 95% CI 10.58, 127.82; p < 0.00001), and the entire laser group (RR 17.37; 95% CI 5.93, 50.81; p < 0.00001). No statistically significant increase in RE rate was described after most of the minimally invasive procedures (p > 0.05). The pooled analysis of MSHQ-EjD scores was possible only for prostatic urethral lift, showing no statistically significant difference between baseline and post-treatment MSHQ-EjD Function scores (WMD -0.80 pts; 95% CI -2.41, 0.81; p = 0.33), but postoperative MSHQ-EjD Bother scores were significantly higher (WMD 0.76 pts; 95% CI 0.22, 1.30; p = 0.006). CONCLUSIONS Erectile function appears to be unaffected by most surgical procedures for BPO. RE is a very common adverse event of BPH surgery, although emerging minimally invasive surgical procedures could be associated with a lower risk. PATIENT SUMMARY Benign prostatic hyperplasia surgery can have an impact on sexual function, mainly involving ejaculatory function.
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Affiliation(s)
- Celeste Manfredi
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Borja García-Gómez
- Department of Urology, Hospital Universitario 12 Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain; ROC Clinic, Madrid, Spain
| | - Davide Arcaniolo
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Esther García-Rojo
- Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain; ROC Clinic, Madrid, Spain
| | - Fabio Crocerossa
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Riccardo Autorino
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | - Christian Gratzke
- Department of Urology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Marco De Sio
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Javier Romero-Otero
- Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain; ROC Clinic, Madrid, Spain.
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Fu Y, Wen X, Yin Y, Wang C, Mai J. Comparison of effectiveness and postoperative complications of different surgical methods in the treatment of benign prostatic hyperplasia: a systematic review and meta-analysis based on randomized controlled trials. Transl Androl Urol 2022; 11:842-858. [PMID: 35812205 PMCID: PMC9262744 DOI: 10.21037/tau-22-377] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/20/2022] [Indexed: 12/13/2022] Open
Abstract
Background More and more new surgical procedures for the treatment of benign prostate hyperplasia (BPH) are proposed creatively. However, the existing clinical evidence shows that the effectiveness and safety of various procedures exist inconsistent. Methods The randomized controlled trials comparing the international prostate score, length of hospital stay, maximum urinary flow rate, operation time, and complication rates of prostatic artery embolization (PAE), Greenlight-XPS Laser prostate vaporization procedure (GLL PVP), diode laser enucleation of prostate (DILEP) and plasmakinetic resection of the prostate (PKRP), transurethral resection of the prostate (TURP) in patients with BPH were screened out in databases. The primary outcome was pooled using a restricted maximum likelihood-based random-effect model and inverse variance-based fixed-effect model. Cochrane Q statistics and I2 statistics were computed to quantify between-study heterogeneity. The risk of bias of each included study was assessed using the revised Cochrane risk of bias tool. Results This meta-analysis ultimately included 14 original research papers, with 1,940 participants enrolled. Eight studies were considered to be at moderate risk of bias, while the others were at mild risk of bias. Although the improvement in functional outcome of the DILEP procedure was equivalent to that of the PKRP procedure, the DILEP procedure group had fewer hospital stays than the PKRP group (P=0.01). In addition, even though the performance of the GLL PVP procedure in the improvement of functional outcome was inferior to the counterpart of TURP (P=0.64), it had a much fewer hospital stays (P=0.01). Moreover, there is still insufficient evidence for the improvement of subjective functional indicators of postoperative patients with PAE compared with TURP [international prostate symptom score (IPSS): P=0.73; IPSS QoL: P=0.91], but achieved less satisfactory objective functional outcomes (Qmax: P=0.06; PVR: P=0.00). Discussion New surgical procedures such as GLL PVP, PAE, and DILEP were safer than traditional TURP procedures. However, it is not superior to traditional surgery in the improvement of clinical symptoms. In clinical practice, the pros and cons of the new operation and the traditional operation should be carefully weighed, and the operation that is most suitable for the patient's condition should be selected.
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Affiliation(s)
- Yujia Fu
- Department of Nuclear Medicine, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Xiaomiao Wen
- Department of Urology, Danzhou People's Hospital, DanZhou, China
| | - Yanhai Yin
- Department of Nuclear Medicine, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Chaoqun Wang
- Department of Nuclear Medicine, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Jiren Mai
- Department of Urology, Sanya People's Hospital/West China (Sanya) Hospital, Sichuan University, Sanya, China
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Urethral stricture following endoscopic prostate surgery: a systematic review and meta-analysis of prospective, randomized trials. World J Urol 2022; 40:1391-1411. [DOI: 10.1007/s00345-022-03946-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/21/2022] [Indexed: 12/19/2022] Open
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Castellani D, Pirola GM, Rubilotta E, Gubbiotti M, Scarcella S, Maggi M, Gauhar V, Teoh JYC, Galosi AB. GreenLight Laser™ Photovaporization versus Transurethral Resection of the Prostate: A Systematic Review and Meta-Analysis. Res Rep Urol 2021; 13:263-271. [PMID: 34295844 PMCID: PMC8290851 DOI: 10.2147/rru.s277482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/05/2021] [Indexed: 11/23/2022] Open
Abstract
GreenLight laser™ photovaporization of the prostate (GLL-PVP) has become a valid alternative to traditional transurethral resection of the prostate (TURP) in men requiring surgery for benign prostatic hyperplasia. We aimed to review systematically the safety and efficacy of studies comparing GLL PVP and TURP in the medium-term. A comprehensive literature search was performed. Twelve studies were identified for meta-analysis. Meta-analyses showed a longer postoperative catheterization time (risk ratio (RR): 1.12, 95% CI:1.09–1.14, p<0.00001) and length of stay (RR: 1.16, 95% CI:1.12–1.19, p<0.00001) in the TURP group; higher risk of transfusion in the TURP group (RR: 6.51, 95% CI: 2,90–14,64 p<0.00001); no difference in the risk of urinary tract infections (RR: 0.83, 95% CI: 0.58–1.18, p=0.30) and transient re-catheterization (RR: 1.11, 95% CI: 0.76–1.60, p=0.60). Regarding reoperation rate, no difference was found in term of postoperative urethral stricture (RR: 1.13, 95% CI: 0.73–1.75, p=0.59) and bladder neck contracture (RR: 0.66, 95% CI: 0.31–1.40, p=0.28). A significantly higher incidence in reoperation for persistent/regrowth adenoma was present in the GLLL-PVP (RR: 0.64, 95% CI: 0.41–0.99, p=0.05). Data at 2-year follow-up showed significant better post-voiding residual (PVR) (MD: -1.42, 95% CI: -2.01, -0.82, p<0.00001) and International Prostate Symptom Score (IPSS) (MD: -0.35, 95% CI: -0.50, -0.20, p<0.00001) after TURP. No difference was found in the mean PVR at 2 years after TURP, in the mean maximum flow rate (Qmax) (MD: 0.30, 95% CI: -0.02–0.61, p=0.06) and quality of life QoL score (MD: 0.05, 95% CI: -0.02–0.42, p=0.13). At 5-year follow-up, data showed better IPSS (MD: -1.70, 95% CI: -2.45,-0.95, p<0.00001), QoL scores (MD: -0.35, 95% CI: -0.69, -0.02, p=0.04) and Qmax (MD: 3.29, 95% CI: 0.19–6.38, p=0.04) after TURP. Data of PVR showed no significant difference (MD: -11.54, 95% CI: -29.55–6.46, p=0.21). In conclusion, our analysis shows that GLL-PVP is a safer and more efficacious procedure than standard TURP in the early and medium-term. However, in the long term period GLL-PVP showed a higher incidence of reoperation rate due to incomplete vaporization/regrowth of prostatic adenoma.
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Affiliation(s)
- Daniele Castellani
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Polytechnic University of Le Marche, Ancona, Italy
| | | | | | | | - Simone Scarcella
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Polytechnic University of Le Marche, Ancona, Italy
| | - Martina Maggi
- Urology Division, La Sapienza University, Rome, Italy
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital (NUHS), Singapore
| | - Jeremy Yuen-Chun Teoh
- S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Andrea Benedetto Galosi
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Polytechnic University of Le Marche, Ancona, Italy
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Bladder neck stenosis after transurethral prostate surgery: a systematic review and meta-analysis. World J Urol 2021; 39:4073-4083. [PMID: 33974100 DOI: 10.1007/s00345-021-03718-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Bladder neck stenosis (BNS) is a long-term complication of surgical procedures for benign prostatic hyperplasia (BPH). We performed a systematic literature review and a meta-analysis of the incidence of BNS after transurethral procedures for BPH. METHODS We performed a systemic literature review using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. We accepted only randomized trials comparing transurethral resection of the prostate (TURP) vs. other transurethral surgery for BPH that were grouped in Ablation vs. Enucleation modalities. The incidences of BNS were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and expressed as Risk Ratios, 95% Confidence Intervals, and p values. Study heterogeneity was assessed utilizing the I2 value. RESULTS 72 studies were identified for meta-analysis, 46 comparing TURP vs. Ablation and 26 TURP vs. Enucleation. The pooled incidence of BNS was 1.3% after TURP, 0.66% after enucleation and 1.2% after Ablation. The incidence of BNS was higher after TURP than after Enucleation but the difference was not statistically significant (RR 1.75 95% CI 0.81-3.79, p = 0.16). There was no significant heterogeneity among the studies (I2 0%, Chi2 4.11, p = 0.90). The incidence of BNS was higher after TURP than after Ablation, but the difference was not statistically significant (RR 1.31, 95% CI 0.82-2.11, p = 0.26) with no significant heterogeneity (I2 0%, Chi2 21.1, p = 0.51). CONCLUSION Our study showed no difference in the rate of BNS incidence among randomized trials comparing TURP vs. Ablation vs. Enucleation and can be used as a reference to counsel patients undergoing BPH surgery.
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Lokeshwar SD, Harper BT, Webb E, Jordan A, Dykes TA, Neal DE, Terris MK, Klaassen Z. Epidemiology and treatment modalities for the management of benign prostatic hyperplasia. Transl Androl Urol 2019; 8:529-539. [PMID: 31807429 DOI: 10.21037/tau.2019.10.01] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is one of the most common conditions affecting men. BPH can lead to a number of symptoms for patients commonly referred to as lower urinary tract symptoms (LUTS). Over the last decade, increased modifiable risk factors, such as metabolic disease and obesity, have resulted in an increased incidence of BPH. This increasing incidence has brought about a multitude of treatment modalities in the last two decades. With so many treatment modalities available, physicians are tasked with selecting the optimal therapy for their patients. Current therapies can first be divided into medical or surgical intervention. Medical therapy for BPH includes 5-alpha-reductase inhibitors and alpha-blockers, or a combination of both. Surgical interventions include a conventional transurethral resection of the prostate (TURP), as well as newer modalities such as bipolar TURP, holmium laser enucleation of the prostate (HoLEP), Greenlight and thulium laser, and prostatic urethral lift (PUL). Emerging therapies in this field must also be further investigated for safety and efficacy. This narrative review attempts to consolidate current and emerging treatment options for BPH and highlights the need for additional investigation on optimizing treatment selection.
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Affiliation(s)
- Soum D Lokeshwar
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Benjamin T Harper
- Division of Urology, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Eric Webb
- Division of Urology, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Andre Jordan
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Thomas A Dykes
- Division of Urology, Charlie Norwood Veteran Affairs Medical Center, Augusta, GA, USA
| | - Durwood E Neal
- Division of Urology, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Martha K Terris
- Division of Urology, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA.,Division of Urology, Charlie Norwood Veteran Affairs Medical Center, Augusta, GA, USA
| | - Zachary Klaassen
- Division of Urology, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
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Lai S, Peng P, Diao T, Hou H, Wang X, Zhang W, Liu M, Zhang Y, Seery S, Wang J. Comparison of photoselective green light laser vaporisation versus traditional transurethral resection for benign prostate hyperplasia: an updated systematic review and meta-analysis of randomised controlled trials and prospective studies. BMJ Open 2019; 9:e028855. [PMID: 31439603 PMCID: PMC6707662 DOI: 10.1136/bmjopen-2018-028855] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To assess the efficacy and safety of green-light laser photoselective vaporisation of the prostate (PVP) compared with transurethral resection of the prostate (TURP) for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). DESIGN Systematic review and meta-analysis, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. DATA SOURCES PubMed, EMBASE, the Cochrane Library until October 2018. ELIGIBILITY CRITERIA Randomised controlled trials and prospective studies comparing the safety and efficacy of PVP versus TURP for LUTS manifesting through BPH. DATA EXTRACTION AND SYNTHESIS Perioperative parameters, complications rates and functional outcomes including treatment-related adverse events such as International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), postvoid residual (PVR), quality of life (QoL) and International Index of Erectile Function (IIEF). RESULTS 22 publications consisting of 2665 patients were analysed. Pooled analysis revealed PVP is associated with reduced blood loss, transfusion, clot retention, TUR syndrome, capsular perforation, catheterisation time and hospitalisation, but also with a higher reintervention rate and longer intervention duration (all p<0.05). No significant difference in IPSS, Qmax, QoL, PVR or IIEF at 3, 24, 36 or 60 months was identified. There was a significant difference in QoL at 6 months (MD=-0.08; 95% CI -0.13 to -0.02; p=0.007), and IPSS (MD = -0.10; 95% CI -0.15 to -0.05; p<0.0001) and Qmax (MD=0.62; 95% CI 0.06 to 1.19; p=0.03) at 12 months, although these differences were not clinically relevant. CONCLUSION PVP is an effective alternative, holding additional safety benefits. PVP has equivalent long-term IPSS, Qmax, QoL, PVR, IIEF efficacy and fewer complications. The main drawbacks are dysuria and reintervention, although both can be managed with non-invasive techniques. The additional shortcoming is that PVP does not acquire histological tissue examination which removes an opportunity to identify prostate cancer.
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Affiliation(s)
- Shicong Lai
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Panxin Peng
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
| | - Tongxiang Diao
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Peking university fifth school of clinical medicine, Beijing, China
| | - Huimin Hou
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xuan Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Wei Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Peking university fifth school of clinical medicine, Beijing, China
| | - Ming Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Yaoguang Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Samuel Seery
- School of Humanities and Social Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianye Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China
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Sun F, Sun X, Shi Q, Zhai Y. Transurethral procedures in the treatment of benign prostatic hyperplasia: A systematic review and meta-analysis of effectiveness and complications. Medicine (Baltimore) 2018; 97:e13360. [PMID: 30572440 PMCID: PMC6320039 DOI: 10.1097/md.0000000000013360] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND With the progress of surgical techniques and instruments, various minimally invasive surgical therapies were developed to treat benign prostatic hyperplasisa (BPH). However, the efficacy and safety of different transurethral procedures for the treatment of BPH are still undefined. METHOD A systematic search was performed for all randomized controlled trials (RCTs), which compared the transurethral procedures for BPH from 1995 to 2016. The clinical baseline characteristics, International Prostate Symptom Score (IPSS), quality of life (QoL), postvoid residual (PVR), maximum flow rate (Qmax), short-term and long-term complications were analyzed using RevMan and ADDIS software. RESULT Eighty-eight randomly controlled trials and fifteen procedures were included in the network meta-analysis. HoLEP greatly inproved PVR. TmLRP had the best efficacy in improving QoL score. Diode laser vaporization of prostate was superior in improving IPSS and Qmax. Diode laser through vaporization required the shortest time in catheterization, while Nd:YAG was the longest procedure. For the hospitalization time, TUR was the longest and HoLEP was the shortest. TmLRP was related to the lowest postoperative hemoglobin decrease. TmLEP had the least rates of occurrence of hematuria, reoperation and erectile dysfunction. HoLEP was the best choice to reduce the incidence of recatheterization, urinary retention, urinary tract infection, stress urinary incontinence and retrograde ejaculation. The complications such as blood transfusion, urethral stricture, bladder neck contracture were relatively rare in the patients who underwent diode laser vaporization of prostate. CONCLUSION Compared with other transurethral procedures, thulium, holmium and diode lasers were associated with better efficacy and fewer complications.
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Nunes R, Oliveira R, Carneiro A, Neto AM, Antunes AA, Bernardo WM, Silvinato A. Benign prostatic hyperplasia: laser prostatectomy (PVP). Rev Assoc Med Bras (1992) 2018; 63:929-940. [PMID: 29451653 DOI: 10.1590/1806-9282.63.11.929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2016] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Rlv Nunes
- Sociedade Brasileira de Urologia (SBU)
| | | | | | - A M Neto
- Sociedade Brasileira de Urologia (SBU)
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Palmero-Martí JL, Panach-Navarrete J, Valls-González L, Ganau-Ituren A, Miralles-Aguado J, Benedicto-Redón A. Comparative study between thulium laser (Tm: YAG) 150W and greenlight laser (LBO:ND-YAG) 120W for the treatment of benign prostatic hyperpplasia: Short-term efficacy and security. Actas Urol Esp 2017; 41:188-193. [PMID: 27894613 DOI: 10.1016/j.acuro.2016.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To compare the results of efficacy and safety of Thulium laser 150W against Greenlight laser 120W in the treatment of short term benign prostatic hyperplasia (12 months after surgery). MATERIAL AND METHODS This is a retrospective observational study where men who underwent the surgical technique of prostate vaporization over a period of four years in our center are included. The homogeneity of the sample was checked, and postoperative complications (acute urinary retention, reentry, need for transfusion), failures per year of surgery (reoperation, peak flow <15ml/sec, no improvement in comparing the I-PSS), and decreased PSA were compared a year after surgery. A bivariate analysis using Chi-square and t-Student was carried out. RESULTS 116 patients were treated with thulium and 118 with green laser. The sample was homogeneous for preoperative variables (P>.05). No differences in complications were observed: in urine acute retention, 4.3% with thulium and 6.8% with green laser (P=.41); in readmissions, 2.6% with thulium and 1.7% with green laser (P=.68); in need for transfusion, 2.6% with thulium and 0% with green laser (P=.12). No differences were observed in the percentage of patients reoperation (1.7% in the group of thulium, 5.1% in the green laser, P=.28); or in individuals with Qmáx less than 15ml/sec (6.9% with thulium, 6.77% with green laser, P=.75), or in the absence of improvement in the IPSS (5, 2% with thulium, 3.4% with green laser, P=.65). There was also no difference in the levels of PSA in ng/mL a year after surgery: with thulium 2.78±2.09 and with green laser 1.83±1.48 (P=.75). CONCLUSIONS Prostate vaporization with thulium laser 150W is comparable to that made with green laser 120W for the treatment of lower urinary tract symptoms caused by BPH, being both effective and safe techniques to 12 months after surgery. Future prospective randomized studies are needed to confirm this conclusion on both techniques.
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Affiliation(s)
- J L Palmero-Martí
- Servicio de Urología, Hospital Universitario de La Ribera, Alzira, Valencia, España
| | - J Panach-Navarrete
- Servicio de Urología, Hospital Universitario de La Ribera, Alzira, Valencia, España.
| | - L Valls-González
- Servicio de Urología, Hospital Universitario de La Ribera, Alzira, Valencia, España
| | - A Ganau-Ituren
- Servicio de Urología, Hospital Universitario de La Ribera, Alzira, Valencia, España
| | - J Miralles-Aguado
- Servicio de Urología, Hospital Universitario de La Ribera, Alzira, Valencia, España
| | - A Benedicto-Redón
- Servicio de Urología, Hospital Universitario de La Ribera, Alzira, Valencia, España
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Older Age and Larger Prostate Volume Are Associated with Stress Urinary Incontinence after Plasmakinetic Enucleation of the Prostate. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6923290. [PMID: 28466017 PMCID: PMC5390649 DOI: 10.1155/2017/6923290] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 01/29/2017] [Indexed: 12/26/2022]
Abstract
Background. To investigate the factors associated with the occurrence of and recovery from stress urinary incontinence (SUI) after plasmakinetic enucleation of the prostate (PKEP). Materials and Methods. This retrospective study enrolled 1,288 patients with benign prostatic hyperplasia treated with plasmakinetic enucleation from January 2008 to January 2015, collecting demographics and clinical parameters. SUI was defined as a patient complaint of involuntary urine leak, including stress or mixed urinary incontinence. Logistic regression analysis was used to investigate the factors associated with the occurrence of SUI. Results. SUI after PKEP occurred in 80 of 1,288 patients (6.2%), 73 of whom (91.3%) recovered within 3 months and 78 of whom (97.5%) recovered within 6 months. In multivariate regression analysis of factors that were significant in univariate analysis, the factors that were significantly associated with postoperative SUI were age ≥ 70 years (odds ratio [OR] = 9.239; 95% confidence interval [CI] = 4.616–18.495; P < 0.001) and prostate volume on transrectal ultrasound ≥ 90 mL (OR = 15.390; 95% CI = 8.077–29.326; P < 0.001). Conclusions. SUI occurred in 6.2% patients after PKEP and was associated with older age and larger prostate volume. We suggest that age and prostate volume be considered in preoperative candidate selection before PKEP to reduce the occurrence of postoperative SUI.
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Kang DH, Cho KS, Ham WS, Choi YD, Lee JY. A Systematic Review and Meta-Analysis of Functional Outcomes and Complications Following the Photoselective Vaporization of the Prostate and Monopolar Transurethral Resection of the Prostate. World J Mens Health 2016; 34:110-22. [PMID: 27574594 PMCID: PMC4999484 DOI: 10.5534/wjmh.2016.34.2.110] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/03/2016] [Accepted: 04/07/2016] [Indexed: 12/15/2022] Open
Abstract
Purpose To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing monopolar transurethral resection of the prostate (MTURP) and photoselective vaporization of the prostate (PVP) in order to provide the most up-to-date and reliable recommendations possible. Materials and Methods Relevant RCTs were identified from electronic databases for meta-analysis of the surgical outcomes and complications of MTURP and PVP. Meta-analytical comparisons were made using qualitative and quantitative syntheses. The outcome variables are presented as odds ratios with 95% confidence intervals (CIs). Results In total, 11 articles were included in this comparative analysis of PVP versus MTURP. Most of the recently published studies exhibited low risk in terms of quality assessment. MTURP was superior to PVP regarding operative time; however, with regard to catheterization and hospitalization time, the mean differences were -1.39 (95% CI=-1.83~-0.95, p<0.001) and -2.21 (95% CI=-2.73~-1.69, p<0.001), respectively, in favor of PVP. PVP was superior to MTURP with regard to transfusion rate and clot retention, but no statistically significant differences were found with regard to acute urinary retention and urinary tract infection. The long-term complications of bladder neck contracture and urethral stricture showed no statistically significant differences between PVP and MTURP. Long-term functional outcomes, including the International Prostate Symptom Score and maximum flow rate, likewise did not display statistically significant differences between PVP and MTURP. Conclusions Based on our findings, we believe that PVP should be considered as an alternative surgical procedure for treating male lower urinary tract symptoms secondary to benign prostatic hyperplasia.
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Affiliation(s)
- Dong Hyuk Kang
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Su Cho
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Sik Ham
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Valdivieso R, Meyer CP, Hueber PA, Meskawi M, Alenizi AM, Azizi M, Trinh QD, Misrai V, Rutman M, Te AE, Chughtai B, Barber NJ, Emara AM, Munver R, Zorn KC. Assessment of energy density usage during 180W lithium triborate laser photoselective vaporization of the prostate for benign prostatic hyperplasia. Is there an optimum amount of kilo-Joules per gram of prostate? BJU Int 2016; 118:633-40. [DOI: 10.1111/bju.13479] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Roger Valdivieso
- Division of Urology; Centre Hospitalier de l'Université de Montréal (CHUM); Montreal QC Canada
| | - Christian P Meyer
- Division of Urologic Surgery and Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Pierre-Alain Hueber
- Division of Urology; Centre Hospitalier de l'Université de Montréal (CHUM); Montreal QC Canada
| | - Malek Meskawi
- Division of Urology; Centre Hospitalier de l'Université de Montréal (CHUM); Montreal QC Canada
| | - Abdullah M. Alenizi
- Division of Urology; Centre Hospitalier de l'Université de Montréal (CHUM); Montreal QC Canada
| | - Mounsif Azizi
- Division of Urology; Centre Hospitalier de l'Université de Montréal (CHUM); Montreal QC Canada
| | - Quoc-Dien Trinh
- Division of Urologic Surgery and Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Vincent Misrai
- Department of Urology; Clinique Pasteur Toulouse; Toulouse France
| | - Matthew Rutman
- Department of Urology; Columbia University; New York NY USA
| | - Alexis E. Te
- Department of Urology; Cornell University; New York NY USA
| | - Bilal Chughtai
- Department of Urology; Cornell University; New York NY USA
| | - Neil J. Barber
- Department of Urology; Frimley Park Hospital; Frimley Surrey UK
| | - Amr M. Emara
- Department of Urology; Frimley Park Hospital; Frimley Surrey UK
| | - Ravi Munver
- Department of Urology; Hackensack University Medical Center; Hackensack NJ USA
| | - Kevin C. Zorn
- Division of Urology; Centre Hospitalier de l'Université de Montréal (CHUM); Montreal QC Canada
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Zhang X, Shen P, He Q, Yin X, Chen Z, Gui H, Shu K, Tang Q, Yang Y, Pan X, Wang J, Chen N, Zeng H. Different lasers in the treatment of benign prostatic hyperplasia: a network meta-analysis. Sci Rep 2016; 6:23503. [PMID: 27009501 PMCID: PMC4806333 DOI: 10.1038/srep23503] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 03/09/2016] [Indexed: 02/05/2023] Open
Abstract
All available surgical treatments for benign prostatic hyperplasia (BPH) have their individual advantages or disadvantages. However, the lack of head-to-head studies comparing different surgeries makes it unavailable to conduct direct analysis. To compare the efficacy and safety among different lasers and transurethral resection of prostate (TURP) for BPH, randomized controlled trials were searched in MEDLINE, EMBASE, Cochrane library, WHO International Clinical Trial Registration Platform, and Clinical Trial.gov by 2015.5; and the effectiveness-, perioperation- and complication-related outcomes were assessed by network meta-analysis. 36 studies involving 3831 patients were included. Holmium laser through resection and enucleation had the best efficacy in maximum flow rate. Thulium laser through vapo-resection was superior in improving international prostate symptom score and holmium laser through enucleation was the best for post-voiding residual volume improvement. Diode laser through vaporization was the rapidest in removing postoperative indwelling catheter, while TURP was the longest. TURP required the longest hospitalization and thulium laser through vapo-resection was relatively shorter. Holmium and thulium lasers seem to be relatively better in surgical efficacy and safety, so that these two lasers might be preferred in selection of optimal laser surgery. Actually, more large-scale and high quality head-to-head RCTs are suggested to validate the conclusions.
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Affiliation(s)
- Xingming Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China, 610041
| | - Pengfei Shen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China, 610041
| | - Qiying He
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China, 610041
| | - Xiaoxue Yin
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China, 610041
| | - Zhibin Chen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China, 610041
| | - Haojun Gui
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China, 610041
| | - Kunpeng Shu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China, 610041
| | - Qidun Tang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China, 610041
| | - Yaojing Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China, 610041
| | - Xiuyi Pan
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China, 610041
| | - Jia Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China, 610041
| | - Ni Chen
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China, 610041
| | - Hao Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China, 610041
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Dołowy Ł, Krajewski W, Dembowski J, Zdrojowy R, Kołodziej A. The role of lasers in modern urology. Cent European J Urol 2015; 68:175-82. [PMID: 26251737 PMCID: PMC4526611 DOI: 10.5173/ceju.2015.537] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/03/2015] [Accepted: 04/17/2015] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The functioning of modern urological departments and the high level of service they provide is possible through, among other things, the use of modern laser techniques. MATERIAL AND METHODS Open operations have been replaced by minimally invasive procedures, and classical surgical tools by advanced lasers. The search for new applications with lasers began as technology developed. Among many devices available, holmium, diode and thulium lasers are currently the most popular. RESULTS Depending on the wavelength, the absorption by water and hemoglobin and the depth of penetration, lasers can be used for coagulation, vaporization and enucleation. In many centres, after all the possibilities of pharmacological treatment have been exhausted, lasers are used as the primary treatment for patients with benign prostatic hyperplasia, with therapeutic results that are better than those obtained through open or endoscopic operations. The use of lasers in the treatment of urolithiasis, urinary strictures and bladder tumours has made treatment of older patients with multiple comorbidities safe, without further necessity to modify the anticoagulant drug treatment. Laser procedures are additionally less invasive, reduce hospitalization time and enable a shorter bladder catheterization time, sometimes even eliminating the need for bladder catherterization completely. Such procedures are also characterized by more stable outcomes and a lower number of reoperations. CONCLUSIONS There are also indications that with the increased competition among laser manufacturers, decreased purchase and maintenance costs, and increased operational safety, laser equipment will become mandatory and indispensable asset in all urology wards.
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Affiliation(s)
- Łukasz Dołowy
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Wojciech Krajewski
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Janusz Dembowski
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Romuald Zdrojowy
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Anna Kołodziej
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
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