Bhatia Ansh, Titus Renil, Porto Joao G, Goradia Rajvi, Shah Khushi, Lopategui Diana, Herrmann Thomas R W, Shah Hemendra N
Miller School of Medicine Desai Sethi Urology Institute, University of Miami Miami Florida USA.
Seth GS Medical College and KEM Hospital Mumbai India.
BJUI Compass. 2024 Oct 30;5(12):1231-1245. doi: 10.1002/bco2.454. eCollection 2024 Dec.
Water Jet Ablation Therapy (WJAT) and Holmium Laser Enucleation of the Prostate (HoLEP) represent two common surgical treatments for Benign Prostatic Hyperplasia (BPH). Despite their increasing use, there is no study between these two methods. We aim to evaluate their efficacy and safety through a network meta-analysis (NMA), providing critical insights for clinical decision-making in the management of moderate to severe lower urinary tract symptoms (LUTS) due to BPH.
Pubmed, EMBASE and Cochrane Library were searched. Randomized controlled trials and prospective single-arm studies comparing WJAT and HoLEP with TURP, reporting symptom scores, flow rates and adverse events. Data extraction and quality assessments were independently performed. Bayesian modelling in RStudio was used for statistical analysis, evaluating continuous outcomes through mean difference and categorical variables via risk ratios. Risk-of-Bias (RoB) and GRADE assessments were performed.
Twenty-three studies were included (WJAT-11, HoLEP-12). Most studies were at some or high risk of bias. At 12 months, the IPSS, Qol, PVR and Qmax improvements were 4.14 points (95% CI: -0.34 to 8.64, not-significant [NS], GRADE-rating: Low), 0.32-points (95% CI:-10.70 to 3.27, NS, GRADE-rating: Low), 2.45 ml/s (95% CI: -1.85 to 7.05, NS, GRADE-rating: Low), 63.10 ml (95% CI: 39.80 to 87.30, statistically-significant [SS], GRADE-rating: Moderate), respectively, all in favour of HoLEP. Haemoglobin-loss was lower with HoLEP, 1.16 g/dl (95% CI: -2.56 to 0.54 mg/dl, NS, GRADE-rating: Moderate) than WJAT. The risk of incontinence was higher with HoLEP; 4.48 (95% CI: 0.22 to 168.50, NS, GRADE-rating: Very Low) than WJAT in single-arm analysis. The risk of blood transfusion was higher with WJAT (RR = 0.14; 95% CI: 0.00 to 4.21, NS, GRADE-rating: Low) than HoLEP. Risk of Total Serious Adverse Events (Clavien-Dindo grade>3) was higher with HoLEP (RR = 1.12, higher with HoLEP, 95% CI: 0.20 to 12.71, NS, GRADE-rating: Low) than WJAT. Retreatment was lower with HoLEP (RR = 0.46, 95% CI: 0.02 to 10.54 GRADE-rating: Low) than WJAT.
Our study suggests that both HoLEP and WJAT are effective treatments for BPH, both with similar IPSS and QoL improvements. HoLEP excels in functional outcomes, particularly in improving Qmax and PVR. Conversely, WJAT, with its shorter operation time and hospital stays, presents a compelling alternative, particularly for outpatient settings.
水刀消融疗法（WJAT）和钬激光前列腺剜除术（HoLEP）是良性前列腺增生（BPH）的两种常见手术治疗方法。尽管它们的使用越来越广泛，但尚未有针对这两种方法的比较研究。我们旨在通过网络荟萃分析（NMA）评估它们的疗效和安全性，为因BPH导致的中度至重度下尿路症状（LUTS）的临床决策提供关键见解。
检索了PubMed、EMBASE和Cochrane图书馆。纳入比较WJAT和HoLEP与经尿道前列腺电切术（TURP）的随机对照试验和前瞻性单臂研究，报告症状评分、流速和不良事件。独立进行数据提取和质量评估。在RStudio中使用贝叶斯模型进行统计分析，通过均值差异评估连续结果，通过风险比评估分类变量。进行了偏倚风险（RoB）和GRADE评估。
纳入了23项研究（WJAT-11项，HoLEP-12项）。大多数研究存在一定或较高的偏倚风险。在12个月时，国际前列腺症状评分（IPSS）、生活质量（Qol）、残余尿量（PVR）和最大尿流率（Qmax）的改善分别为4.14分（95%可信区间：-0.34至8.64，无统计学意义[NS]，GRADE分级：低）、0.32分（95%可信区间：-10.70至3.27，NS，GRADE分级：低）、2.45毫升/秒（95%可信区间：-1.85至7.05，NS，GRADE分级：低）、63.10毫升（95%可信区间：39.80至87.30，有统计学意义[SS]，GRADE分级：中等），均有利于HoLEP。HoLEP的血红蛋白损失较低，为1.16克/分升（95%可信区间：-2.56至0.54毫克/分升，NS，GRADE分级：中等），低于WJAT。HoLEP的尿失禁风险较高；单臂分析中，HoLEP的尿失禁风险为WJAT的4.48倍（95%可信区间：0.22至168.50，NS，GRADE分级：极低）。WJAT的输血风险高于HoLEP（风险比=0.14；95%可信区间：0.00至4.21，NS，GRADE分级：低）。HoLEP的严重不良事件总风险（Clavien-Dindo分级>3）高于WJAT（风险比=1.12，HoLEP更高，95%可信区间：0.20至12.71，NS，GRADE分级：低）。HoLEP的再次治疗率低于WJAT（风险比=0.46，95%可信区间：0.02至10.54，GRADE分级：低）。
我们的研究表明，HoLEP和WJAT都是治疗BPH的有效方法，两者在IPSS和QoL改善方面相似。HoLEP在功能结局方面表现出色，尤其是在改善Qmax和PVR方面。相反，WJAT手术时间和住院时间较短，是一个有吸引力的选择，特别是在门诊环境中。
