Wang Zhichao, Tan Zicheng, Qiu Mengzhen, Zhang Longyang
Department of Urology, Jinan Central Hospital, Shandong University, Jinan, China.
Department of Urology, Jinan Central Hospital, Shandong Second Medical University, Jinan, China.
Curr Urol. 2025 Jan;19(1):17-29. doi: 10.1097/CU9.0000000000000247. Epub 2024 Apr 15.
We compared the safety and efficacy of treating benign prostatic hyperplasia with photoselective greenlight vaporization (PVP) versus holmium laser enucleation of the prostate (HoLEP).
Databases (PubMed, Embase, Cochrane Library, Chinese CBM, and CNKI) were searched for eligible studies evaluating HoLEP or PVP outcomes, published until May 2022. We analyzed the incidence of relative complications and postoperative outcomes, including the international prostate symptom score, maximum flow rate (Qmax), postvoid residual urine volume, quality of life index, and prostate-specific antigen levels.
Eleven studies involving 4763 patients were included in this meta-analysis. The significant differences in postoperative Qmax at 1 month (mean difference [MD], 3.31, 95% confidence interval [CI], 0.45-6.16, = 0.02, , 92%), 3 months (MD, 2.78, 95% CI, 0.53-5.02, = 0.02, , 89%), 6 months (MD, 2.13, 95% CI, 1.11-3.15, < 0.0001, , 87%), and 12 months (MD, 3.98, 95% CI, 2.06-5.89, < 0.0001, , 58%) further confirmed unique advantage of HoLEP over PVP. We used forest plots to determine significant differences in the severe complication rates among patients in the PVP and HoLEP groups (odds ratio, 0.05, 95% CI, 0.01 to 0.28, = 0.0005).
Holmium laser enucleation of the prostate and PVP showed comparable international prostate symptom scores, quality of life index, postvoid residual urine volumes, prostate-specific antigen levels, perioperative factors, and total complication rates. Compared with PVP, HoLEP had a greater Qmax 1 year postoperatively, decreased energy expenditure, and fewer high-grade complications. These results need to be verified in long-term follow-up studies with well-structured randomized controlled trials.
我们比较了选择性绿激光汽化术（PVP）与钬激光前列腺剜除术（HoLEP）治疗良性前列腺增生的安全性和有效性。
检索数据库（PubMed、Embase、Cochrane图书馆、中国生物医学文献数据库和中国知网），查找截至2022年5月发表的评估HoLEP或PVP疗效的符合条件的研究。我们分析了相关并发症的发生率和术后结果，包括国际前列腺症状评分、最大尿流率（Qmax）、残余尿量、生活质量指数和前列腺特异性抗原水平。
本荟萃分析纳入了11项涉及4763例患者的研究。1个月时术后Qmax的显著差异（平均差[MD]，3.31，95%置信区间[CI]，0.45 - 6.16，P = 0.02，I² = 92%）、3个月时（MD，2.78，95% CI，0.53 - 5.02，P = 0.02，I² = 89%）、6个月时（MD，2.13，95% CI，1.11 - 3.15，P < 0.0001，I² = 87%）和12个月时（MD，3.98，95% CI，2.06 - 5.89，P < 0.0001，I² = 58%）进一步证实了HoLEP相对于PVP的独特优势。我们使用森林图确定PVP组和HoLEP组患者严重并发症发生率的显著差异（比值比，0.05，95% CI，0.01至0.28，P = 0.0005）。
钬激光前列腺剜除术和PVP在国际前列腺症状评分、生活质量指数、残余尿量、前列腺特异性抗原水平、围手术期因素和总并发症发生率方面表现相当，但与PVP相比，HoLEP术后1年的Qmax更高，能量消耗更低，高级别并发症更少。这些结果需要在设计良好的随机对照试验的长期随访研究中得到验证。
