Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland.
World J Urol. 2021 Jul;39(7):2383-2396. doi: 10.1007/s00345-021-03705-6. Epub 2021 May 6.
Various techniques for EEP exist. They differ by surgical steps and the source of energy. It is assumed that the latter is of minor importance, whereas adherence to the anatomical enucleation template determines the postoperative result. So far, no systematic review highlights the differences between the energy sources in use for anatomical EEP. This study will address selfsame topic.
A systematic review of the literature was completed on September 1st, 2020. Studies comparing HoLEP, ThuLEP, DiLEP, or BipolEP with TUR-P providing 12 months of postoperative follow-up were included. Two frequentist network meta-analyses were created to compare the techniques of EEP indirectly.
31 studies, including 4466 patients, were found eligible for our meta-analysis. Indirect pairwise comparison showed differences in surgery time between BipolEP and HolEP (MD - 16.72 min., 95% CI - 27.75 to - 5.69) and DiLEP and HoLEP (MD - 22.41 min., 95% CI - 39.43 to - 5.39). No differences in the amount of resected prostatic tissue, major and minor complications and postoperative catheterization time were found. The odds for blood transfusions were threefold higher for BipolEP than for HoLEP (OR 3.27, 95% CI 1.02-10.5). The difference was not statistically significant when comparing prospective trials and matched-pair analysis only (OR 3.25, 95% CI 0.94-11.18). The Qmax 12 months after surgery was 2 ml/sec. higher for BipolEP than for DiLEP (MD 2.00, 95% CI 0.17-3.84) and 1.94 ml/sec. lower for DiLEP than for HoLEP (MD - 1.94, 95% CI - 3.65 to - 0.22).
The energy source used for EEP has an impact on the intervention itself. BipolEP promotes surgical efficiency; laser techniques lower the risk of bleeding.
This meta-analysis is registered in the PROSPERO international prospective register registry with the registration number CRD42020205836.
存在各种 EEP 技术。它们的区别在于手术步骤和能量源。后者被认为是次要的，而遵循解剖性切除术模板则决定了术后结果。到目前为止，还没有系统的综述强调用于解剖性 EEP 的能量源之间的差异。本研究将探讨同样的主题。
我们于 2020 年 9 月 1 日完成了文献的系统综述。纳入了比较 HoLEP、ThuLEP、DiLEP 或 BipolEP 与 TUR-P（提供 12 个月的术后随访）的研究。我们创建了两个频率网络荟萃分析，以间接比较 EEP 的技术。
我们发现 31 项研究，包括 4466 名患者，符合我们的荟萃分析条件。间接成对比较显示，BipolEP 与 HolEP 之间的手术时间存在差异（MD-16.72 分钟，95%CI-27.75 至-5.69），DiLEP 与 HoLEP 之间的手术时间也存在差异（MD-22.41 分钟，95%CI-39.43 至-5.39）。在切除的前列腺组织量、主要和次要并发症以及术后导尿时间方面没有差异。与 HolEP 相比，BipolEP 输血的几率高 3 倍（OR3.27，95%CI1.02-10.5）。仅比较前瞻性试验和配对分析时，差异无统计学意义（OR3.25，95%CI0.94-11.18）。手术后 12 个月时，BipolEP 的 Qmax 比 DiLEP 高 2.00ml/sec（MD2.00，95%CI0.17-3.84），而 DiLEP 比 HoLEP 低 1.94ml/sec（MD-1.94，95%CI-3.65 至-0.22）。
用于 EEP 的能量源对干预本身有影响。BipolEP 促进手术效率；激光技术降低出血风险。
本荟萃分析在 PROSPERO 国际前瞻性登记处注册，注册号为 CRD42020205836。
