Holmium laser enucleation versus bipolar resection in the management of large‐volume benign prostatic hyperplasia: A randomized controlled trial

Habib, E; Abdallah, Mohamed F.; ElSheemy, Mohammed S.; Badawy, Mohamed; Nour, Hany H; Kamal, Ahmad M.; AbdelMohsen, Mostafa; Roshdy, Mamdouh; Meshref, Alaa

doi:10.1111/iju.14737

Cited by 11 publications

(9 citation statements)

References 7 publications

(29 reference statements)

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“…A total of 449 articles were searched in the database, and there were only 57 articles left after reading the title and abstract. By reviewing the full-text articles and qualitative synthesis, 11 studies were finally included in our meta-analysis ( Elshal et al, 2020 ; Fuschi et al, 2021 ; Ghobrial et al, 2021 ; Guo, 2020 ; Habib et al, 2020 , 2022 ; Higazy et al, 2021 ; Kuntz et al, 2004 , 2008 ; Kuntz & Lehrich, 2002 ; J. Zhang et al, 2020 ). The details of included studies were presented in Figure 1 , and the characteristics and baseline are summarized in Table 2 .…”

Section: Resultsmentioning

confidence: 99%

The Efficacy and Safety of HoLEP for Benign Prostatic Hyperplasia With Large Volume: A Systematic Review and Meta-Analysis

et al. 2022

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This meta-analysis was to evaluate the efficacy and safety of holmium laser enucleation of prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) with large volume. PubMed, Embase, and Cochrane Library databases (until March 2022) were used to search related randomized controlled trials. A total of 11 studies including 1,258 patients were involved. HoLEP could significantly decrease the length of hospital stay and accelerate recovery. In subanalysis, HoLEP had better perioperative outcomes than bipolar transurethral resection of the prostate (B-TURP) and bipolar transurethral enucleation of the prostate (BPEP). The improvement in operative time and enucleation time was better in thulium laser enucleation of the prostate (ThuLEP) than HoLEP. In the follow-up period, the HoLEP decreased post-void residual urine (PVR) in short-term intervals and improved patients’ maximum flow rate (Qmax) and prostate-specific antigen (PSA) in mid- and long-term intervals. In subanalysis, HoLEP presented significant improvements in Qmax, PSA, and quality of life (QoL) than B-TURP, and HoLEP could also improve Qmax than ThuLEP after 6 months of surgery. The HoLEP reduced the risk of postoperative bleeding compared with other surgeries in safety. In our study, we confirmed the advantages of HoLEP in treating BPH when the prostate size was larger than 80 mL, which indicated that HoLEP could be the best choice for treatment of large volume of prostate.

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Section: Resultsmentioning

confidence: 99%

The Efficacy and Safety of HoLEP for Benign Prostatic Hyperplasia With Large Volume: A Systematic Review and Meta-Analysis

et al. 2022

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“…RCTs of GreenLight and HoLEP versus TURP report significant benefits with the laser treatments in terms of catheterisation time and hospital length of stay. 23 , 24 GreenLight is also shown to have significantly lower perioperative bleeding compared to TURP, 23 while HoLEP does not but does have significantly shorter operative time compared to TURP. 24 Similar results have been reported for HoLEP versus bipolar enucleation, 25 and bipolar enucleation has been shown to be superior to bTURP with respect to operative time, catheterisation time, postoperative bleeding complications and bladder neck contracture.…”

Section: Discussionmentioning

confidence: 97%

The Efficacy and Safety of Laser and Electrosurgical Transurethral Procedures for the Treatment of BPO in High-Risk Patients: A Systematic Review

Burtt¹,

Springate²,

Martin³

et al. 2022

RRU

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Objective To compare efficacy and safety outcomes of GreenLight, Holmium and Thulium laser  techniques with standard monopolar and bipolar transurethral resection of the prostate (TURP) in high-risk patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). Methods We conducted a systematic literature review of studies in patients undergoing BPO surgeries who may be considered high-risk for standard TURP, with higher risk defined as follows: large prostates (≥80 mL) and/or taking antithrombotic agents and/or urinary retention and/or age >80 years and/or significant comorbidity.  Outcomes summarised included bleeding complications, re-intervention rates, hospital length of stay, and standard measures of disease and symptom severity for all available timepoints. Results A total of 276 studies of 32,722 patients reported relevant data. Studies were heterogeneous in methodology, population and outcomes reported. IPSS reduction, Qmax improvement and PVR were similar across all interventions. Mean values at baseline and after 12 months across interventions were 13.2−29 falling to 2.3−10.8 for IPSS, 0−19 mL/s increasing to 7.5−34.1 mL/s for Qmax and 41.4−954 mL falling to 5.1−138.3 mL for PVR. Laser treatments show some advantages compared with monopolar and bipolar TURP for some adverse events and safety parameters such as bleeding complications. Duration of hospital stay, reinterventions and recatheterisations were lower with GreenLight, HoLEP, Thulium lasers, and bipolar enucleation than TURP. Conclusions Laser therapies are effective and well-tolerated treatment options in high-risk patients with BPO compared with monopolar or bipolar TURP. The advantageous safety profile of laser treatments means that patients with a higher bleeding risk should be offered laser surgery preferentially to mTURP or bTURP.

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“…Most studies reported shorter hospitalization durations with PVP, ThuVARP, DiLEP, and HoLEP than with TURP [ 24 , 25 , 26 , 27 ]. Some smaller studies reported no significant differences in hospitalization duration between HoLEP and B-TURP [ 25 , 28 ]. Our study revealed significantly shorter hospitalization durations with PVP, ThuVARP, and DiLEP than with M-TURP but not with HoLEP and B-TURP.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Emergency Room Visits and Rehospitalization for Bleeding Complications following Transurethral Procedures for the Treatment of Benign Prostatic Hyperplasia: A Population-Based Retrospective Cohort Study

Chen

Hsu

Wang

et al. 2022

JCM

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Background: The postoperative bleeding complications associated with laser surgery of the prostate and transurethral resection of the prostate (TURP) were compared. Methods: We used the Taiwan National Health Insurance Research Database to conduct an observational population-based cohort study. All eligible patients who received transurethral procedures between January 2015 and September 2018 were enrolled. Patients who received laser surgery or TURP were matched at a ratio of 1:1 by using propensity score matching, and the association of these procedures with bleeding events was evaluated. Results: A total of 3302 patients who underwent elective transurethral procedures were included. The multivariable Cox regression analysis revealed that diode laser enucleation of the prostate (DiLEP) resulted in significantly higher emergency room risks within 90 days after surgery due to clot retention than the Monopolar transurethral resection of the prostate (M-TURP) (Hazard Ratio: 1.52; 95% Confidence Interval [CI], 1.06–2.16, p = 0.022). Moreover, GreenLight photovaporization of the prostate (PVP) (0.61; 95% CI, 0.38–1.00 p = 0.050) and thulium laser vaporesection of the prostate (ThuVARP) (0.67; 95% CI, 0.47–0.95, p = 0.024) resulted in significantly fewer rehospitalization due to clot retention than did M-TURP. No significant increase in blood clots were observed in patients using comedications and those with different demographic characteristics and comorbidities. Conclusions: Among the investigated six transurethral procedures for Benign prostatic hyperplasia, PVP and ThuVARP were safer than M-TURP because bleeding events and clot retention were less likely to occur, even in patients receiving anticoagulant or antiplatelet therapy. However, DiLEP and holmium laser enucleation of the prostate (HoLEP) did not result in fewer bleeding events than M-TURP.

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Holmium laser enucleation versus bipolar resection in the management of large‐volume benign prostatic hyperplasia: A randomized controlled trial

Cited by 11 publications

References 7 publications

The Efficacy and Safety of HoLEP for Benign Prostatic Hyperplasia With Large Volume: A Systematic Review and Meta-Analysis

The Efficacy and Safety of HoLEP for Benign Prostatic Hyperplasia With Large Volume: A Systematic Review and Meta-Analysis

The Efficacy and Safety of Laser and Electrosurgical Transurethral Procedures for the Treatment of BPO in High-Risk Patients: A Systematic Review

Comparison of Emergency Room Visits and Rehospitalization for Bleeding Complications following Transurethral Procedures for the Treatment of Benign Prostatic Hyperplasia: A Population-Based Retrospective Cohort Study

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