钬激光与钬：钇铝石榴石激光用于前列腺内镜剜除术的系统评价和Meta分析

Thulium Fiber Versus Holmium:Yttrium-aluminum-garnet Laser for Endoscopic Enucleation of the Prostate: A Systematic Review and Meta-analysis.

作者信息

Uleri Alessandro, Long Depaquit Thibaut, Farré Alba, Cornu Jean Nicolas, Schwartzmann Ivan, Castellani Daniele, Gauhar Vineet, Misrai Vincent, Diana Pietro, Saita Alberto, Doizi Steeve, Rajwa Pawel, Herrmann Thomas R W, Baboudjian Michael

机构信息

Department of Urology, North Academic Hospital, AP-HM, Marseille, France; Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy.

Department of Urology, North Academic Hospital, AP-HM, Marseille, France.

出版信息

Eur Urol Focus. 2024 Dec;10(6):914-921. doi: 10.1016/j.euf.2024.06.005. Epub 2024 Jun 18.

DOI:10.1016/j.euf.2024.06.005

PMID:38897872

Abstract

BACKGROUND AND OBJECTIVE

Thulium fiber laser (TFL) emerged as a competitor of holmium:yttrium-aluminum-garnet (Ho:YAG) laser for anatomic enucleation of the prostate (AEEP) in men with lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO). The aim was to compare the surgical outcomes of Ho:YAG and TFL for AEEP.

METHODS

A literature search was conducted to identify reports published from inception until January 2024. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed to identify eligible studies. The coprimary outcomes were the postoperative International Prostate Symptom Score (IPSS), IPSS-Quality of Life (IPSS-QoL), and peak urinary flow (Qmax).

KEY FINDINGS AND LIMITATIONS

Five studies met our inclusion criteria, and data from 1287 and 1555 patients who underwent AEEP with Ho:YAG (holmium laser enucleation of the prostate [HoLEP]) and TFL (thulium fiber laser enucleation of the prostate [ThuFLEP]), respectively, were reviewed. ThuFLEP was associated with a better IPSS at 3 mo even if the difference was not clinically significant (mean difference [MD] 0.59, 95% confidence interval [CI]: 0.29-0.88; p < 0.001). No difference was found for IPSS at 6-12 mo (p = 0.9), and IPSS-QoL at 3 mo (p = 0.9) and 6-12 mo (p = 0.2). HoLEP was associated with a better Qmax at 3 mo (MD 1.41 ml/s, 95% CI: 0.51-2.30; p = 0.002) and ThuFLEP at 6-12 mo (MD -2.61 ml/s, 95% CI: -4.68 to 0.59; p = 0.01), but the differences were not clinically significant. No difference was found in the major (p = 0.3) and overall (p = 0.3) complication rates. HoLEP was associated with shorter enucleation (MD -11.86, 95% CI: -22.36 to 1.36; p = 0.03) but not total operative time (p = 0.5).

CONCLUSIONS AND CLINICAL IMPLICATIONS

The present review provides the most updated evidence on the impact of Ho:YAG and TFL in AEEP, demonstrating that these two energy sources are effective in relieving bothersome LUTS in men with BPO.

PATIENT SUMMARY

Thulium fiber laser is a new energy source that can be used safely for performing endoscopic enucleation of the prostate in men with bothersome symptoms associated with benign prostatic enlargement.

摘要

背景与目的

对于患有与良性前列腺梗阻（BPO）相关的下尿路症状（LUTS）的男性，铥光纤激光（TFL）成为钬：钇铝石榴石（Ho:YAG）激光用于前列腺解剖性剜除术（AEEP）的竞争对手。目的是比较Ho:YAG和TFL用于AEEP的手术效果。

方法

进行文献检索以识别从开始到2024年1月发表的报告。遵循系统评价和Meta分析的首选报告项目指南来识别符合条件的研究。共同主要结局是术后国际前列腺症状评分（IPSS）、IPSS生活质量（IPSS-QoL）和最大尿流率（Qmax）。

主要发现与局限性

五项研究符合我们的纳入标准，分别对1287例接受Ho:YAG前列腺钬激光剜除术（HoLEP）和1555例接受TFL前列腺铥光纤激光剜除术（ThuFLEP）的AEEP患者的数据进行了回顾。ThuFLEP在术后3个月时与更好的IPSS相关，即使差异无临床意义（平均差[MD]0.59，95%置信区间[CI]：0.29 - 0.88；p < 0.001）。在术后6 - 12个月时IPSS无差异（p = 0.9），术后3个月时IPSS-QoL无差异（p = 0.9），术后6 - 12个月时IPSS-QoL无差异（p = 0.2）。HoLEP在术后3个月时与更好的Qmax相关（MD 1.41 ml/s，95% CI：0.51 - 2.30；p = 0.002），ThuFLEP在术后6 - 12个月时与更好的Qmax相关（MD - （此处原文有误，应为ThuFLEP在术后6 - 12个月时与更低的Qmax相关，MD - 2.61 ml/s，95% CI：- 4.68至0.59；p = 0.01），但差异无临床意义。主要（p = 0.3）和总体（p = 0.3）并发症发生率无差异。HoLEP与更短的剜除时间相关（MD - 11.86，95% CI：- 22.36至1.36；p = 0.03），但与总手术时间无关（p = 0.5）。