Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
Department of Urology, Spital Thurgau AG Frauenfeld, Münsterlingen, Switzerland; Department of Urology, Hanover Medical School, Hannover, Germany.
Eur Urol Focus. 2022 Mar;8(2):545-554. doi: 10.1016/j.euf.2021.03.024. Epub 2021 Apr 8.
Holmium (HoLEP) and thulium laser enucleation of the prostate (ThuLEP) are the two methods most commonly applied for endoscopic enucleation of the prostate. It remains unclear which of the two is superior in terms of outcome and complications.
To compare perioperative and functional outcomes between HoLEP and ThuLEP.
A systematic review and meta-analysis were performed according to the recommendations of the Cochrane Collaboration and in line with the PRISMA criteria. A comprehensive database search including MEDLINE, Web of Science, CINAHL, ClinicalTrials.gov, and CENTRAL was conducted according to the PICO criteria. Only randomized controlled trials (RCTs) were considered. All review steps were conducted by two independent reviewers. Risk of bias was assessed using the revised Cochrane tool for RCTs.
The search identified 556 studies, of which four were eligible for qualitative and quantitative analysis, reporting on a total of 579 patients with follow-up of up to 18 months. No significant differences in operating time, enucleation weight, catheterization time, or hospital stay were observed between ThuLEP and HoLEP. The decrease in hemoglobin was significantly lower for ThuLEP (mean difference -0.54 g/dl, 95% confidence interval [CI] -0.93 to -0.15; p < 0.001), but with low certainty of evidence. Transient urinary incontinence was more common for HoLEP (odds ratio 0.56, 95% CI 0.32-0.99; p = 0.045), again with low certainty of evidence. Furthermore, no significant differences were observed for other complications or for functional measures and symptom scores.
ThuLEP and HoLEP offer comparable improvement in symptoms and postoperative voiding parameters. Both procedures are safe and major complications are rare. ThuLEP showed minor advantages for blood loss and the incidence of transient incontinence. This should be interpreted with caution owing to the low certainty of evidence. Therefore, treatment choice should be based on surgeon expertise and local conditions.
We reviewed four clinical trials that compared holmium and thulium lasers for treatment to reduce the size of the prostate gland. Our review assessed outcomes and complications. We found that both laser techniques are safe and suitable for reducing symptoms due to an enlarged prostate. Blood loss and short-lasting urinary incontinence were slightly lower after thulium compared to holmium laser treatment.
钬激光前列腺剜除术（HoLEP）和铥激光前列腺剜除术（ThuLEP）是两种最常用于内镜前列腺剜除术的方法。目前尚不清楚这两种方法在疗效和并发症方面哪一种更优。
比较 HoLEP 和 ThuLEP 围手术期和功能结局。
根据 Cochrane 协作组织的建议并按照 PRISMA 标准进行系统评价和荟萃分析。根据 PICO 标准，对 MEDLINE、Web of Science、CINAHL、ClinicalTrials.gov 和 CENTRAL 进行全面的数据库检索。仅考虑随机对照试验（RCT）。所有的审查步骤都由两名独立的审查员进行。使用改良 Cochrane RCT 工具评估偏倚风险。
检索出 556 篇研究，其中 4 篇符合定性和定量分析的条件，共报告了 579 例患者的随访时间长达 18 个月。ThuLEP 和 HoLEP 之间的手术时间、剜除重量、导管时间或住院时间无显著差异。与 HoLEP 相比，ThuLEP 的血红蛋白下降幅度明显较低（平均差值 -0.54 g/dl，95%置信区间 [CI] -0.93 至 -0.15；p < 0.001），但证据确定性低。HoLEP 中短暂性尿失禁更为常见（比值比 0.56，95%CI 0.32-0.99；p = 0.045），同样证据确定性低。此外，其他并发症或功能测量和症状评分均无显著差异。
ThuLEP 和 HoLEP 均能显著改善症状和术后排尿参数。两种方法均安全，主要并发症罕见。与 HoLEP 相比，ThuLEP 具有轻微的优势，即失血量较少，且短暂性尿失禁的发生率较低。这应该谨慎解释，因为证据确定性低。因此，治疗选择应基于外科医生的专业知识和当地条件。
我们回顾了四项比较钬激光和铥激光治疗以缩小前列腺体积的临床试验。我们的综述评估了疗效和并发症。我们发现，这两种激光技术都安全，适合减轻因前列腺增大引起的症状。与钬激光治疗相比，铥激光治疗后失血量和短期尿失禁略低。
