Pirola Giacomo Maria, Castellani Daniele, Maggi Martina, Lim Ee Jean, Chan Vinson Wai Shun, Naselli Angelo, Teoh Jeremy Yuen Chun, Gauhar Vineet
Department of Urology, San Giuseppe Hospital, Multimedica Group, Milano, Italy.
Department of Urology, University Hospital 'Ospedali Riuniti' and Polytechnic University of Marche Region, Ancona, Italy.
Cent European J Urol. 2022;75(2):153-161. doi: 10.5173/ceju.2022.0104. Epub 2022 Jun 22.
The aim of this article was to enumerate the differences in immediate and postoperative outcomes for holmium laser enucleation of the prostate (HoLEP) performed with low-power (LP) or high-power (HP) laser settings through a systematic review of comparative studies.
We performed a systematic literature review using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. Potential clinical differences among LP and HP HoLEP were determined using the PICOS (Patient Intervention Comparison Outcome Study type) model, where outcomes were surgical time, operative efficiency, postoperative catheterization time, length of hospital stay, blood transfusion, incontinence rate, maximum urinary flow rate (QMax) and International Prostatic Symptom score (IPSS). Retrospective, prospective nonrandomized, randomized studies, and meeting abstracts were considered.
A total of five studies were included for meta-analysis. No significant differences between LP and HP HoLEP were evidenced in terms of intraoperative variables (surgical time, surgical efficiency); postoperative outcomes (length of stay, length of catheterization); postoperative complications; functional results (IPSS; Qmax). Urinary incontinence rate did not differ between the two groups (OR 0.95, 95% CI 0.362.47, p = 0.91).
The study shows equal outcomes in outcomes from HoLEP performed with LP or HP energy settings. Even if further comparative studies are still needed to increase the level of evidence, those results encourage a further clinical adoption of LP HoLEP.
本文旨在通过对比较研究的系统评价，列举低功率（LP）或高功率（HP）激光设置下钬激光前列腺剜除术（HoLEP）的即刻和术后结果差异。
我们使用MEDLINE、EMBASE和Cochrane中央对照试验注册库进行了系统的文献综述。使用PICOS（患者、干预措施、对照、结局、研究类型）模型确定LP和HP HoLEP之间潜在的临床差异，结局指标包括手术时间、手术效率、术后导尿时间、住院时间、输血情况、尿失禁率、最大尿流率（QMax）和国际前列腺症状评分（IPSS）。纳入回顾性、前瞻性非随机、随机研究以及会议摘要。
共纳入五项研究进行荟萃分析。LP和HP HoLEP在术中变量（手术时间、手术效率）、术后结局（住院时间、导尿时间）、术后并发症、功能结果（IPSS；Qmax）方面均未显示出显著差异。两组间尿失禁率无差异（OR 0.95，95%CI 0.36 - 2.47，p = 0.91）。
该研究表明，LP或HP能量设置下的HoLEP结果相当。即使仍需要进一步的比较研究来提高证据水平，但这些结果鼓励在临床上进一步采用LP HoLEP。
