Abi Chebel Josselin, Sarkis Julien, El Helou Elie, Hanna Elie, Abi Tayeh Georges, Semaan Albert
Department of Urology, Hôtel-Dieu de France Hospital, Beirut, Lebanon.
Arab J Urol. 2020 Aug 11;19(2):123-129. doi: 10.1080/2090598X.2020.1789809.
To perform a systematic review and meta-analysis of available prospective and retrospective studies comparing the minimally invasive (laparoscopic or robot-assisted) simple prostatectomy (MISP) and laser enucleation of the prostate for treating male lower urinary tract symptoms in high-volume prostates, as laser enucleation of the prostate is the new trend for treating high-volume prostates (>80 mL) but many urologists now prefer MISP.
A systematic search was done using the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Cochrane databases in June 2019, with research terms including: 'laser', 'laparoscopy', 'enucleation', 'BPH', 'simple prostatectomy', 'Millins', and 'adenomectomy'. The meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Of 38 screened articles, six were analysed and a total of 975 men were included. The average operative time, length of stay and catheterisation time were significantly shorter in the laser enucleation group ( = 0.006, < 0.001 and P < 0.001, respectively). The amount of prostatic tissue removed during surgery was comparable between both the laser enucleation and MISP groups ( = 0.39). The International Prostate Symptom Score, prostate-specific antigen level, maximum urinary flow rate and post-void residual urine volume were also comparable at 3 months. Finally, similar transfusion rates and Clavien-Dindo complication rates were observed ( = 0.08 and = 0.41, respectively).
This systematic review of the literature and meta-analysis provide a further demonstration of the safety and effectiveness of both laser enucleation and MISP. While laser enucleation had a shorter catheterisation time and hospital stay than MISP, the latter still had unique and specific indications. ELEP: eraser laser enucleation of the prostate; HoLEP: holmium laser enucleation of the prostate; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PVR: post-void residual urine volume; Q: maximum urinary flow rate; (L)(MI)(RA)SP: (laparoscopic) (minimally-invasive) (robot-assisted) simple prostatectomy.
对现有的前瞻性和回顾性研究进行系统评价和荟萃分析，比较微创（腹腔镜或机器人辅助）单纯前列腺切除术（MISP）与前列腺激光剜除术治疗大体积前列腺男性下尿路症状的效果，因为前列腺激光剜除术是治疗大体积前列腺（>80 mL）的新趋势，但现在许多泌尿科医生更倾向于MISP。
2019年6月使用医学文献分析和检索系统在线（MEDLINE）及Cochrane数据库进行系统检索，检索词包括：“激光”“腹腔镜检查”“剜除术”“良性前列腺增生”“单纯前列腺切除术”“米林斯手术”及“腺瘤切除术”。根据系统评价和荟萃分析的首选报告项目（PRISMA）指南进行荟萃分析。
在38篇筛选出的文章中，6篇进行了分析，共纳入975名男性。激光剜除术组的平均手术时间、住院时间和导尿时间显著更短（分别为P = 0.006、P < 0.001和P < 0.001）。手术中切除的前列腺组织量在激光剜除术组和MISP组之间相当（P = 0.39）。3个月时，国际前列腺症状评分、前列腺特异性抗原水平、最大尿流率和残余尿量也相当。最后，观察到相似的输血率和Clavien-Dindo并发症发生率（分别为P = 0.08和P = 0.41）。
对文献的这项系统评价和荟萃分析进一步证明了激光剜除术和MISP的安全性和有效性。虽然激光剜除术的导尿时间和住院时间比MISP短，但后者仍有独特且特定的适应症。ELEP：前列腺橡皮擦激光剜除术；HoLEP：钬激光前列腺剜除术；PRISMA：系统评价和荟萃分析的首选报告项目；PVR：残余尿量；Q：最大尿流率；(L)(MI)(RA)SP：（腹腔镜）（微创）（机器人辅助）单纯前列腺切除术
