The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China.
Department of Urology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, No. 158, Shangtang Road, Xiacheng District, Hangzhou, 310014, Zhejiang, China.
Lasers Med Sci. 2021 Aug;36(6):1191-1200. doi: 10.1007/s10103-020-03153-5. Epub 2020 Oct 12.
The benefit of transurethral laser prostatectomy over open simple prostatectomy (OSP) is controversial in aged symptomatic benign prostatic hyperplasia (BPH) patients with large volume prostates, and the aim of this study is to compare the safety and efficiency of these two methods. Meta-analysis was applied using the Review Manager V5.3 software and the retrieved randomized controlled clinical trials (RCTs) comparing transurethral laser prostatectomy with OSP were analyzed for the treatment of large volume prostates from 2000 to 2019 in PubMed, Web of Science, Cochrane, and EMBASE datasets. Five RCTs assessing transurethral laser prostatectomy versus OSP were considered suitable for this meta-analysis, which included a total of 448 patients, with 232 patients undergoing laser and 216 patients undergoing OSP. Compared with OSP, although transurethral laser prostatectomy required a longer operative time (weighted mean difference (WMD) 27.49 mins; 95% confidence interval (CI) 16.54-38.44; P < 0.00001) and obtained a less resected prostate weight (WMD - 11.72 g; 95% CI - 21.75 to - 1.70; P = 0.02), patients undergoing laser prostatectomy benefited from significantly less hemoglobin decline (- 0.97 g/dL; 95% CI - 1.31 to - 0.64; P < 0.00001), shorter time of catheterization (WMD - 3.67 days; 95% CI - 5.60 to - 1.75; P = 0.0002), shorter length of hospital stay (WMD - 4.75 days; 95% CI - 6.57 to - 2.93; P < 0.00001), and less blood transfusion (odds ratio 0.10; 95% CI 0.03 to 0.35; P = 0.0003). During postoperative follow-up, no significant difference was observed between the two groups in IPSS, QoL, Q, and PVR. Both transurethral laser prostatectomy and OSP are safe and effective for large prostates that require prostate resection. Taking into account of less blood loss, shorter catheterization time and hospital stay, and less blood transfusion, transurethral laser prostatectomy may be a better treatment for patients with large prostates.
经尿道激光前列腺切除术与开放性单纯前列腺切除术（OSP）治疗大体积前列腺的疗效比较：一项荟萃分析。目的：对于有症状的良性前列腺增生（BPH）老年患者，大体积前列腺的经尿道激光前列腺切除术优于开放性单纯前列腺切除术，但仍存在争议。本研究旨在比较这两种方法的安全性和有效性。方法：应用 Review Manager V5.3 软件进行荟萃分析，检索 2000 年至 2019 年期间在 PubMed、Web of Science、Cochrane 和 EMBASE 数据库中比较经尿道激光前列腺切除术与 OSP 治疗大体积前列腺的随机对照临床试验（RCT）。纳入符合标准的 5 项 RCT 进行荟萃分析，共纳入 448 例患者，其中 232 例行激光治疗，216 例行 OSP。结果：与 OSP 相比，虽然经尿道激光前列腺切除术的手术时间更长（加权均数差（WMD）27.49 分钟；95%置信区间（CI）16.54-38.44；P<0.00001），切除的前列腺组织重量更少（WMD-11.72g；95%CI-21.75 至-1.70；P=0.02），但激光前列腺切除术的患者受益于血红蛋白下降幅度显著减小（WMD-0.97g/dL；95%CI-1.31 至-0.64；P<0.00001）、导尿管留置时间缩短（WMD-3.67 天；95%CI-5.60 至-1.75；P=0.02）、住院时间缩短（WMD-4.75 天；95%CI-6.57 至-2.93；P<0.00001）和输血减少（比值比 0.10；95%CI 0.03 至 0.35；P=0.0003）。术后随访时，两组患者的国际前列腺症状评分（IPSS）、生活质量（QoL）、Q 最大值和膀胱残余尿量（PVR）均无显著差异。结论：经尿道激光前列腺切除术和 OSP 均可安全有效地治疗需要前列腺切除术的大体积前列腺。考虑到经尿道激光前列腺切除术的出血量较少、导尿管留置时间和住院时间较短、输血较少，对于大体积前列腺患者，经尿道激光前列腺切除术可能是一种更好的治疗选择。
