1 Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China .
J Endourol. 2014 Jan;28(1):65-72. doi: 10.1089/end.2013.0404. Epub 2013 Nov 4.
To assess the efficacy and safety of thulium laser resection of the prostate (TmLRP) vs transurethral resection of the prostate (TURP) for treating patients with benign prostatic hyperplasia (BPH).
A systematic search of the electronic databases, including Medline, Scopus, China National Knowledge Infrastructure, and the Cochrane Library was performed up to May 1, 2013. The pooled outcomes of interest assessing the two techniques included demographic and clinical baseline characteristics, perioperative variables, complications, and postoperative efficacy including maximum flow rate (Qmax), postvoid residual (PVR), quality of life (QoL) and International Prostate Symptom Score (IPSS).
Nine trials assessing TmLRP vs. TURP were considered suitable for meta-analysis including three randomized controlled trials (RCTs), two prospective, and four retrospective studies. Compared with TURP, although TmLRP needed a longer operative time (weighted mean difference [WMD]: 9.00 min; 95% confidence interval [CI], 2.53-15.47; P=0.006), patients having TmLRP might benefit from significantly less serum sodium decreased (-3.58 mmol/L; 95% CI, -4.04 to -3.12; P<0.001), less serum hemoglobin decreased (WMD: -0.94 mmol/L; 95% CI, -1.44 to -0.44; P<0.001), shorter time of catheterization (WMD: -2.07 days; 95% CI, -2.66 to -1.49; P<0.001), shorter length of hospital stay (WMD: -1.87 days; 95% CI, -2.41 to -1.33; P<0.001), and fewer total complications (odds ratio [OR]: 0.29; 95% CI, 0.20-0.41; P<0.001). During the 1, 3, 6, and 12 months of postoperative follow-up, the procedures did not demonstrate a significant difference in Qmax, IPSS, PVR, and QoL.
Our data suggest that as a promising minimally invasive technique, TmLRP appears to be a safe, feasible, and efficient alternative to TURP for treating patients with BPH with reliable perioperative safety, fewer complications, and comparable efficacy in relation to Qmax, PVR, QoL, and IPSS. Because of the inherent limitations of the included studies, further large sample prospective, multicentric, long-term follow-up studies and RCTs should be undertaken to confirm our findings.
评估钬激光前列腺切除术（TmLRP）与经尿道前列腺切除术（TURP）治疗良性前列腺增生（BPH）患者的疗效和安全性。
系统检索电子数据库，包括 Medline、Scopus、中国知网和 Cochrane 图书馆，检索截至 2013 年 5 月 1 日。评估两种技术的汇总结局指标包括人口统计学和临床基线特征、围手术期变量、并发症以及术后疗效，包括最大尿流率（Qmax）、残余尿量（PVR）、生活质量（QoL）和国际前列腺症状评分（IPSS）。
纳入了 9 项 TmLRP 与 TURP 比较的研究，包括 3 项随机对照试验（RCT）、2 项前瞻性研究和 4 项回顾性研究。与 TURP 相比，尽管 TmLRP 手术时间更长（加权均数差 [WMD]：9.00 分钟；95%置信区间 [CI]：2.53-15.47；P=0.006），但 TmLRP 组患者的血清钠降低幅度更小（WMD：-3.58 mmol/L；95% CI：-4.04 至 -3.12；P<0.001），血红蛋白降低幅度更小（WMD：-0.94 mmol/L；95% CI：-1.44 至 -0.44；P<0.001），导尿管留置时间更短（WMD：-2.07 天；95% CI：-2.66 至 -1.49；P<0.001），住院时间更短（WMD：-1.87 天；95% CI：-2.41 至 -1.33；P<0.001），总并发症更少（比值比 [OR]：0.29；95% CI：0.20-0.41；P<0.001）。在术后 1、3、6 和 12 个月的随访中，两种手术方法在 Qmax、IPSS、PVR 和 QoL 方面均未显示出显著差异。
我们的数据表明，作为一种有前途的微创技术，TmLRP 似乎是一种安全、可行且有效的 TURP 替代方法，用于治疗 BPH 患者，具有可靠的围手术期安全性、更少的并发症，并且在 Qmax、PVR、QoL 和 IPSS 方面的疗效相当。由于纳入研究的固有局限性，应进一步开展大样本、多中心、长期随访研究和 RCT，以证实我们的研究结果。
