Pang Karl H, Ortner Gernot, Yuan Yuhong, Biyani Chandra Shekhar, Tokas Theodoros
Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
Department of Urology and Andrology, General Hospital Hall i.T., Hall in Tirol, Austria.
Cent European J Urol. 2022;75(4):357-386. doi: 10.5173/ceju.2022.174. Epub 2022 Nov 24.
There are several endoscopic enucleation procedures (EEP) using different energy sources: holmium laser enucleation of the prostate (HoLEP), thulium laser enucleation of the prostate (ThuLEP), Greenlight (GreenVEP) and diode (DiLEP) lasers, and plasma kinetic enucleation of the prostate (PKEP). The comparative outcomes among these EEPs are unclear. We aimed to compare the peri-operative and post-operative outcomes, complications and functional outcomes among different EEPs.
A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist. Only randomised-controlled trials (RCT) comparing EEPs were included. The risk of bias was assessed using the Cochrane tool for RCTs.
The search identified 1153 articles and 12 RCTs were included. The number of RCTs for each comparison was, HoLEP vs ThuLEP; n = 3, HoLEP vs PKEP; n = 3, PKEP vs DiLEP; n = 3, HoLEP vs GreenVEP; n = 1, HoLEP vs DiLEP; n = 1, ThuLEP vs PKEP; n = 1. Operative time was shorter and blood loss was lower with ThuLEP compared with HoLEP, whereas operative time was shorter for HoLEP compared with PKEP. Blood loss was lower with HoLEP and DiLEP compared with PKEP. There were no Clavien-Dindo IV-V complications, and the incidence of Clavien-Dindo I complications was lower with ThuLEP compared with HoLEP. No significant differences were detected among EEPs regarding urinary retention, stress urinary incontinence, bladder neck contracture or urethral stricture. Lower International Prostate Symptom Score (IPSS) and higher quality of life (QoL) scores were in favour of ThuLEP compared with HoLEP at 1 month.
EEP improves symptoms and uroflowmetry parameters with a low incidence of high-grade complications. ThuLEP was associated with shorter operative time, lower blood loss, and lower incidence of low-grade complications compared with HoLEP.
有几种使用不同能量源的内镜剜除术（EEP）：钬激光前列腺剜除术（HoLEP）、铥激光前列腺剜除术（ThuLEP）、绿激光（GreenVEP）和二极管激光（DiLEP），以及等离子体动力前列腺剜除术（PKEP）。这些EEP之间的比较结果尚不清楚。我们旨在比较不同EEP的围手术期和术后结果、并发症及功能结果。
根据系统评价和Meta分析的首选报告项目（PRISMA）清单进行系统评价和Meta分析。仅纳入比较EEP的随机对照试验（RCT）。使用Cochrane随机对照试验工具评估偏倚风险。
检索到1153篇文章，纳入12项RCT。每项比较的RCT数量分别为：HoLEP与ThuLEP比较；n = 3，HoLEP与PKEP比较；n = 3，PKEP与DiLEP比较；n = 3，HoLEP与GreenVEP比较；n = 1，HoLEP与DiLEP比较；n = 1，ThuLEP与PKEP比较；n = 1。与HoLEP相比，ThuLEP的手术时间更短，失血更少，而与PKEP相比，HoLEP的手术时间更短。与PKEP相比，HoLEP和DiLEP的失血更少。未出现Clavien-Dindo IV-V级并发症，与HoLEP相比，ThuLEP的Clavien-Dindo I级并发症发生率更低。在尿潴留、压力性尿失禁、膀胱颈挛缩或尿道狭窄方面，各EEP之间未检测到显著差异。与HoLEP相比，在1个月时，ThuLEP的国际前列腺症状评分（IPSS）更低，生活质量（QoL）评分更高。
EEP可改善症状和尿流率参数，高级别并发症发生率低。与HoLEP相比，ThuLEP的手术时间更短，失血更少，低级别并发症发生率更低。
