Li Sheng, Zeng Xian-Tao, Ruan Xiao-Lan, Weng Hong, Liu Tong-Zu, Wang Xiao, Zhang Chao, Meng Zhe, Wang Xing-Huan
Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan, People's Republic of China.
Center for Evidence-based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, People's Republic of China.
PLoS One. 2014 Jul 8;9(7):e101615. doi: 10.1371/journal.pone.0101615. eCollection 2014.
Holmium laser enucleation (HoLEP) in surgical treatment of benign prostate hyperplasia (BPH) potentially offers advantages over transurethral resection of the prostate (TURP).
Published randomized controlled trials (RCTs) were identified from PubMed, EMBASE, Science Citation Index, and the Cochrane Library up to October 10, 2013 (updated on February 5, 2014). After methodological quality assessment and data extraction, meta-analysis was performed using STATA 12.0 and Trial Sequential Analysis (TSA) 0.9 software.
Fifteen studies including 8 RCTs involving 855 patients met the criteria. The results of meta-analysis showed that: a) efficacy indicators: there was no significant difference in quality of life between the two groups (P>0.05), but compared with the TURP group, Qmax was better at 3 months and 12 months, PVR was less at 6, 12 months, and IPSS was lower at 12 months in the HoLEP, b) safety indicators: compared with the TURP, HoLEP had less blood transfusion (RR 0.17, 95% CI 0.06 to 0.47), but there was no significant difference in early and late postoperative complications (P>0.05), and c) perioperative indicators: HoLEP was associated with longer operation time (WMD 14.19 min, 95% CI 6.30 to 22.08 min), shorter catheterization time (WMD -19.97 h, 95% CI -24.24 to -15.70 h) and hospital stay (WMD -25.25 h, 95% CI -29.81 to -20.68 h).
In conventional meta-analyses, there is no clinically relevant difference in early and late postoperative complications between the two techniques, but HoLEP is preferable due to advantage in the curative effect, less blood transfusion rate, shorter catheterization duration time and hospital stay. However, trial sequential analysis does not allow us to draw any solid conclusion in overall clinical benefit comparison between the two approaches. Further large, well-designed, multicentre/international RCTs with long-term data and the comparison between the two approaches remain open.
钬激光剜除术（HoLEP）在良性前列腺增生（BPH）的外科治疗中可能比经尿道前列腺切除术（TURP）具有优势。
从PubMed、EMBASE、科学引文索引和Cochrane图书馆中检索截至2013年10月10日（2014年2月5日更新）发表的随机对照试验（RCT）。在进行方法学质量评估和数据提取后，使用STATA 12.0和试验序贯分析（TSA）0.9软件进行荟萃分析。
15项研究（包括8项RCT，涉及855例患者）符合标准。荟萃分析结果显示：a）疗效指标：两组生活质量无显著差异（P>0.05），但与TURP组相比，HoLEP组在3个月和12个月时的最大尿流率（Qmax）更好，在6个月和12个月时的残余尿量（PVR）更少，在12个月时的国际前列腺症状评分（IPSS）更低；b）安全性指标：与TURP相比，HoLEP组输血更少（RR 0.17，95%CI 0.06至0.47），但术后早期和晚期并发症无显著差异（P>0.05）；c）围手术期指标：HoLEP组手术时间更长（WMD 14.19分钟，95%CI 6.30至22.08分钟），导尿时间更短（WMD -19.97小时，95%CI -24.24至-15.70小时），住院时间更短（WMD -25.25小时，95%CI -29.81至-20.68小时）。
在传统的荟萃分析中，两种技术术后早期和晚期并发症在临床上无显著差异，但由于HoLEP在疗效、输血率更低、导尿持续时间和住院时间更短方面具有优势，因此更可取。然而，试验序贯分析不允许我们在两种方法的总体临床益处比较中得出任何确凿结论。需要进一步开展大型、设计良好的多中心/国际RCT，并提供长期数据，两种方法之间的比较仍有待进行。
