1470 nm Diode Laser Enucleation vs Plasmakinetic Resection of the Prostate for Benign Prostatic Hyperplasia: A Randomized Study

Abstract

Objective: The purpose of the current work was to comparatively assess 1470 nm diode laser enucleation of the prostate (DiLEP) and plasmakinetic resection of the prostate (PKRP) for treating benign prostatic hyperplasia (BPH). Patients and Methods: From January 2016 to March 2017, 157 individuals with bladder outflow obstruction caused by BPH were randomized to DiLEP and PKRP groups, for prospective analysis. Of these, 152 cases were evaluated before operation and at 3, 6, and 12 months postsurgery. Patient baseline properties, presurgery data, and postsurgical outcomes were comparatively assessed, as well as complications. Results: There were no significant preoperative differences between surgical groups. DiLEP-treated cases showed remarkable reduced operative time, postsurgical bladder irrigation time, catheterization duration, and hospital stay compared with the PKRP group ( P < 0.001). Hemoglobin amount decrease was markedly less pronounced after DiLEP ( P = 0.004). However, no patients needed blood transfusion in either group. The decrease in sodium level showed no marked differences between the DiLEP and PKRP groups ( P = 0.380). In addition, complications were comparable and no significant differences in both groups. At 3, 6, and 12 months, International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), and postvoid residual (PVR) were similar in both groups ( P > 0.05). Conclusions: DiLEP and PKRP are similar in efficacy and safety for relieving obstruction and low urinary tract symptoms. Compared with PKRP, DiLEP has decreased risk of hemorrhage, operative time, bladder irrigation time, catheterization duration, and hospital stay. However, IPSS, QoL, Qmax, and PVR were similar for both procedures within 12 postoperative months.

Randomised trial of bipolar resection vs holmium laser enucleation vs Greenlight laser vapo‐enucleation of the prostate for treatment of large benign prostate obstruction: 3‐years outcomes

“…In a study by Zhang et al . [19], diode laser enucleation of the prostate and bipolar resection had comparable urinary functional outcomes at 12 months. However, enucleation was associated with less perioperative bleeding, operative time, time to catheter removal, and hospital stay.…”

Endoscopic enucleation of the prostate (EEP). The same but different—a systematic review

“…In total, 31 studies were found eligible for our analysis-21 prospective randomized trials, of which 11 compare HoLEP [20][21][22][23][24][25][26][27][28][29][30], 3 ThuLEP [31][32][33], 2 DiLEP [13,34], and 5 BipolEP Fig. 1 Flow diagram of the study selection process: this graphic provides an overview of the study selection process.…”

Surgical outcome of anatomical endoscopic enucleation of the prostate: A systemic review and meta‐analysis

“…These 21 trials were published between 2004 and 2019 with total 2,957 patients. The enrolled studies included the comparisons: HoLEP versus TURP ( n = 9) (Ahyai et al., 2007; Chen et al., 2013; Fayad et al., 2015; Gilling et al., 2012; Gupta, Sivaramakrishna, Kumar, Dogra, & Seth, 2006; Jhanwar et al., 2017; Montorsi et al., 2004; Sun et al., 2014; Wilson et al., 2006), HoLEP versus OP ( n = 2) (Kuntz, Lehrich, & Ahyai, 2008; Naspro et al., 2006), BipolEP versus TURP ( n = 3) (Luo, Shen, Guan, Li, & Wang, 2014; Zhao et al., 2010; Zhu et al., 2013), BipolEP versus OP ( n = 4) (Chen et al., 2014; Geavlete, Stanescu, Iacoboaie, & Geavlete, 2013; Ou et al., 2013; Rao et al., 2013), ThuLEP versus TURP ( n = 1) (Yang, Wang, & Liu, 2013), ThuFLEP versus TURP ( n = 1) (Enikeev, Netsch, et al, 2019) and DiLEP versus TURP ( n = 1) (Zhang, Wang, et al, 2019). Baseline patient characteristics and the methodological quality of the 21 included trials are listed in Table 1.…”

“…A total of 15 trials reporting the post‐operative IPSS of EEP versus TURP were retrieved and analysed (Ahyai et al., 2007; Chen et al., 2013; Enikeev, Netsch, et al, 2019; Fayad et al., 2015; Gilling et al., 2012; Gupta et al., 2006; Jhanwar et al., 2017; Luo et al., 2014; Montorsi et al., 2004; Sun et al., 2014; Wilson et al., 2006; Yang et al., 2013; Zhang, Wang, et al, 2019; Zhao et al., 2010; Zhu et al., 2013).…”

“…Only one RCT comparing DiLEP with TURP was identified by our literature search (Zhang, Wang, et al, 2019). Compared to TURP, DiLEP was associated with better perioperative outcomes (less operation time, less haemoglobin loss, less bladder irrigation and shorter duration of catheterisation and hospitalisation) and had comparable functional outcomes (IPSS, QoL, PVR, Qmax) (Zhang, Wang, et al, 2019). GreenLight laser has been traditionally used for vaporisation in BPH surgery.…”