Yan Jiusong, Gao Liang, Xu Guangyong, Zhang Junyong
Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China.
Heliyon. 2022 Oct 4;8(10):e10884. doi: 10.1016/j.heliyon.2022.e10884. eCollection 2022 Oct.
To evaluate the effectiveness and safety of transurethral resection of the prostate (TURP), holmium laser enucleation of the prostate (HoLEP) and thulium laser enucleation of the prostate (ThuLEP) in the treatment of benign prostatic hyperplasia using a network Meta-analysis.
Randomized controlled trials of TURP, HoLEP and ThuLEP for benign prostatic hyperplasia were collected by computerized searches of databases including CNKI, WANFANG, VIP, PubMed, The Cochrane Library, the Web of Science and Embase, with a search time frame of build to January 2022. The literature was screened and data was extracted by two investigators separately, while the risk of bias of the included studies was evaluated before systematic evaluation and network meta-analysis using ADDIS 1.16.8 software and RevMan 5.3 software.
A total of 27 RCTs with a total of 3335 patients were involved. The results of the network meta-analysis showed that ThuLEP was better than the remaining two procedures in terms of enhancing patients' subjective perception and improving objective indicators, and the incidence of adverse events such as postoperative urethral stricture and urinary incontinence was lower compared with that of conventional TURP in both short- and long-term postoperative follow-ups.
As ThuLEP is effective, safe, and featured with few postoperative complications, it can be the preferred surgical procedure for prostate enlargement. Nevertheless, because of the limited number of studies included, more-sample, multicenter, double-blind clinical randomized controlled trials are required in the future to further verify the findings of the present study.
采用网状Meta分析评价经尿道前列腺电切术（TURP）、钬激光前列腺剜除术（HoLEP）和铥激光前列腺剜除术（ThuLEP）治疗良性前列腺增生的有效性和安全性。
通过计算机检索中国知网（CNKI）、万方、维普、PubMed、考克兰图书馆、科学引文索引（Web of Science）和Embase等数据库，收集TURP、HoLEP和ThuLEP治疗良性前列腺增生的随机对照试验，检索时间范围为建库至2022年1月。由两名研究者分别进行文献筛选和数据提取，同时在系统评价和网状Meta分析前，使用ADDIS 1.16.8软件和RevMan 5.3软件评估纳入研究的偏倚风险。
共纳入27项随机对照试验，总计3335例患者。网状Meta分析结果显示，在增强患者主观感受和改善客观指标方面，ThuLEP优于其余两种手术方式，且在术后短期和长期随访中，与传统TURP相比，术后尿道狭窄和尿失禁等不良事件的发生率更低。
由于ThuLEP有效、安全且术后并发症少，可作为前列腺增生的首选手术方式。然而，鉴于纳入研究数量有限，未来需要更多样本、多中心、双盲临床随机对照试验进一步验证本研究结果。
