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Holmium laser enucleation versus simple prostatectomy for treating large prostates: Results of a systematic review and meta-analysis.
Arab J Urol. 2016 Mar; 14(1):50-8.AJ

Abstract

OBJECTIVE

To compare and evaluate the safety and efficacy of holmium laser enucleation of the prostate (HoLEP) and simple prostatectomy for large prostate burdens, as discussion and debate continue about the optimal surgical intervention for this common pathology.

MATERIALS AND METHODS

A systematic search was conducted for studies comparing HoLEP with simple prostatectomy [open (OP), robot-assisted, laparoscopic] using a sensitive strategy and in accordance with Cochrane collaboration guidelines. Primary parameters of interest were objective measurements including maximum urinary flow rate (Q max) and post-void residual urine volume (PVR), and subjective outcomes including International Prostate Symptom Score (IPSS) and quality of life (QoL). Secondary outcomes of interest included volume of tissue retrieved, catheterisation time, hospital stay, blood loss and serum sodium decrease. Data on baseline characteristics and complications were also collected. Where possible, comparable data were combined and meta-analysis was conducted.

RESULTS

In all, 310 articles were identified and after screening abstracts (114) and full manuscripts (14), three randomised studies (263 patients) were included, which met our pre-defined inclusion criteria. All these compared HoLEP with OP. The mean transrectal ultrasonography (TRUS) volume was 113.9 mL in the HoLEP group and 119.4 mL in the OP group. There was no statistically significant difference in Q max, PVR, IPSS and QoL at 12 and 24 months between the two interventions. OP was associated with a significantly shorter operative time (P = 0.01) and greater tissue retrieved (P < 0.001). However, with HoLEP there was significantly less blood loss (P < 0.001), patients had a shorter hospital stay (P = 0.03), and were catheterised for significantly fewer hours (P = 0.01). There were no significant differences in the total number of complications recorded amongst HoLEP and OP (P = 0.80).

CONCLUSION

The results of the meta-analysis have shown that HoLEP and OP possess similar overall efficacy profiles for both objective and subjective disease status outcome measures. This review shows these improvements persist to at least the 24 month follow-up point. Further randomised studies are warranted to fully determine the optimal surgical intervention for large prostate burdens.

Authors+Show Affiliations

Blackpool Victoria Hospital, Blackpool, Lancashire, UK.Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK.Lister Hospital, Stevenage, Hertfordshire, UK.University Hospital Southampton NHS Trust, Southampton, Hampshire, UK.St. Joseph's Hospital, Newport, South Wales, UK.Islamic University of Gaza, College of Medicine, Gaza, Palestine.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

26966594

Citation

Jones, Patrick, et al. "Holmium Laser Enucleation Versus Simple Prostatectomy for Treating Large Prostates: Results of a Systematic Review and Meta-analysis." Arab Journal of Urology, vol. 14, no. 1, 2016, pp. 50-8.
Jones P, Alzweri L, Rai BP, et al. Holmium laser enucleation versus simple prostatectomy for treating large prostates: Results of a systematic review and meta-analysis. Arab J Urol. 2016;14(1):50-8.
Jones, P., Alzweri, L., Rai, B. P., Somani, B. K., Bates, C., & Aboumarzouk, O. M. (2016). Holmium laser enucleation versus simple prostatectomy for treating large prostates: Results of a systematic review and meta-analysis. Arab Journal of Urology, 14(1), 50-8. https://doi.org/10.1016/j.aju.2015.10.001
Jones P, et al. Holmium Laser Enucleation Versus Simple Prostatectomy for Treating Large Prostates: Results of a Systematic Review and Meta-analysis. Arab J Urol. 2016;14(1):50-8. PubMed PMID: 26966594.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Holmium laser enucleation versus simple prostatectomy for treating large prostates: Results of a systematic review and meta-analysis. AU - Jones,Patrick, AU - Alzweri,Laith, AU - Rai,Bhavan Prasad, AU - Somani,Bhaskar K, AU - Bates,Chris, AU - Aboumarzouk,Omar M, Y1 - 2015/11/26/ PY - 2015/07/22/received PY - 2015/09/27/revised PY - 2015/10/17/accepted PY - 2016/3/12/entrez PY - 2016/3/12/pubmed PY - 2016/3/12/medline KW - BPH KW - HoLEP KW - HoLEP, holmium enucleation of the prostate KW - Holmium KW - LASP, laparoscopic simple prostatectomy KW - Lasers KW - MeSH, Medical Subject heading KW - OP, open prostatectomy KW - PVR, post-void residual urine volume KW - Prostatectomy KW - Qmax, maximum urinary flow rate KW - QoL, quality of life KW - RASP, robot-assisted simple prostatectomy KW - RCT, randomised controlled trial KW - WMD, weighted mean difference SP - 50 EP - 8 JF - Arab journal of urology JO - Arab J Urol VL - 14 IS - 1 N2 - OBJECTIVE: To compare and evaluate the safety and efficacy of holmium laser enucleation of the prostate (HoLEP) and simple prostatectomy for large prostate burdens, as discussion and debate continue about the optimal surgical intervention for this common pathology. MATERIALS AND METHODS: A systematic search was conducted for studies comparing HoLEP with simple prostatectomy [open (OP), robot-assisted, laparoscopic] using a sensitive strategy and in accordance with Cochrane collaboration guidelines. Primary parameters of interest were objective measurements including maximum urinary flow rate (Q max) and post-void residual urine volume (PVR), and subjective outcomes including International Prostate Symptom Score (IPSS) and quality of life (QoL). Secondary outcomes of interest included volume of tissue retrieved, catheterisation time, hospital stay, blood loss and serum sodium decrease. Data on baseline characteristics and complications were also collected. Where possible, comparable data were combined and meta-analysis was conducted. RESULTS: In all, 310 articles were identified and after screening abstracts (114) and full manuscripts (14), three randomised studies (263 patients) were included, which met our pre-defined inclusion criteria. All these compared HoLEP with OP. The mean transrectal ultrasonography (TRUS) volume was 113.9 mL in the HoLEP group and 119.4 mL in the OP group. There was no statistically significant difference in Q max, PVR, IPSS and QoL at 12 and 24 months between the two interventions. OP was associated with a significantly shorter operative time (P = 0.01) and greater tissue retrieved (P < 0.001). However, with HoLEP there was significantly less blood loss (P < 0.001), patients had a shorter hospital stay (P = 0.03), and were catheterised for significantly fewer hours (P = 0.01). There were no significant differences in the total number of complications recorded amongst HoLEP and OP (P = 0.80). CONCLUSION: The results of the meta-analysis have shown that HoLEP and OP possess similar overall efficacy profiles for both objective and subjective disease status outcome measures. This review shows these improvements persist to at least the 24 month follow-up point. Further randomised studies are warranted to fully determine the optimal surgical intervention for large prostate burdens. SN - 2090-598X UR - https://www.unboundmedicine.com/medline/citation/26966594/Holmium_laser_enucleation_versus_simple_prostatectomy_for_treating_large_prostates:_Results_of_a_systematic_review_and_meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2090-598X(15)00131-X DB - PRIME DP - Unbound Medicine ER -
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