Zhou Yan, Xue Boxin, Mohammad Nadeem Ahmed, Chen Dong, Sun Xiaofei, Yang Jinhui, Dai Guangcheng
Department of Urology, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Suzhou, Jiangsu, China.
Lasers Med Sci. 2016 Apr;31(3):485-95. doi: 10.1007/s10103-016-1895-x. Epub 2016 Feb 11.
To assess the efficacy and the safety of Greenlight(TM) high-performance system (HPS) 120-W laser photoselective vaporization of the prostate (PVP) compared with transurethral resection of the prostate (TURP) for treatment of benign prostatic hyperplasia (BPH). The related original studies only including randomized controlled trials were searched by databases MEDLINE, EMBASE, Google Scholar, and the Cochrane Controlled Trial Register. The databases were updated till July 2014. The risk ratio, mean difference, and their corresponding 95% confidence intervals were calculated. Risk of bias of the enrolled trials were assessed according to Cochrane Handbook. A total of four trials involving 559 patients were enrolled. Statistical analysis was performed by software Review Manager (V5.3.3). There was no significant difference in International Prostate Symptom Score (IPSS) and maximum flow rate (Qmax) between PVP and TURP at 6-, 12-, and 24-month follow-up. Patients in the PVP group were associated with significantly lower risk of capsule perforation (risk ratio (RR) = 0.06, 95% confidence interval (95%CI) = 0.01 to 0.46; p = 0.007), significantly lower transfusion requirements (RR = 0.12, 95%CI = 0.03 to 0.43; p = 0.001), a shorter catheterization time (mean difference (MD) = -41.93, 95%CI = -54.87 to -28.99; p < 0.00001), and a shorter duration of hospital stay (MD = -2.09, 95%CI = -2.58 to -1.59; p < 0.00001) than that in the TURP group. In the TURP group, the patients were associated with a lower risk of re-operation (RR = 3.68, 95%CI = 1.04 to 13.00; p = 0.04) and a shorter operative time (MD = 9.28, 95%CI = 2.80 to 15.75; p = 0.005) than those in the PVP group. In addition, no statistically significant differences were detected between groups in terms of the rates of transurethral resection syndrome, urethral stricture, bladder neck contracture, incontinence, and infection. Greenlight(TM) 120-W laser PVP is as effective as TURP for symptom reduction and improvement of the quality of life. Laser PVP shows advantages over TURP in terms of intraoperative safety, whereas TURP is found to have a shorter operative time and lower re-operative risk.
为评估绿激光（Greenlight™）高性能系统（HPS）120W激光选择性前列腺汽化术（PVP）与经尿道前列腺切除术（TURP）治疗良性前列腺增生（BPH）的疗效和安全性。通过MEDLINE、EMBASE、谷歌学术和Cochrane对照试验注册库检索仅纳入随机对照试验的相关原始研究。数据库更新至2014年7月。计算风险比、平均差及其相应的95%置信区间。根据Cochrane手册评估纳入试验的偏倚风险。共纳入4项试验，涉及559例患者。采用Review Manager（V5.3.3）软件进行统计分析。在6个月、12个月和24个月随访时，PVP组和TURP组的国际前列腺症状评分（IPSS）和最大尿流率（Qmax）无显著差异。PVP组患者包膜穿孔风险显著较低（风险比（RR）=0.06，95%置信区间（95%CI）=0.01至0.46；p=0.007），输血需求显著较低（RR=0.12，95%CI=0.03至0.43；p=0.001），导尿时间较短（平均差（MD）=-41.93，95%CI=-54.87至-28.99；p<0.00001），住院时间较短（MD=-2.09，95%CI=-2.58至-1.59；p<0.00001）。在TURP组，患者再次手术风险较低（RR=3.68，95%CI=1.04至13.00；p=0.04），手术时间较短（MD=9.28，95%CI=2.80至15.75；p=0.005）。此外，两组在经尿道切除综合征、尿道狭窄、膀胱颈挛缩、尿失禁和感染发生率方面未检测到统计学显著差异。绿激光（Greenlight™）120W激光PVP在减轻症状和改善生活质量方面与TURP同样有效。激光PVP在术中安全性方面优于TURP，而TURP手术时间较短且再次手术风险较低。
