Transurethral laser versus open simple prostatectomy for large volume prostates: a systematic review and meta-analysis of randomized controlled trials

The benefit of transurethral laser prostatectomy over open simple prostatectomy (OSP) is controversial in aged symptomatic benign prostatic hyperplasia (BPH) patients with large volume prostates, and the aim of this study is to compare the safety and efficiency of these two methods. Meta-analysis was applied using the Review Manager V5.3 software and the retrieved randomized controlled clinical trials (RCTs) comparing transurethral laser prostatectomy with OSP were analyzed for the treatment of large volume prostates from 2000 to 2019 in PubMed, Web of Science, Cochrane, and EMBASE datasets. Five RCTs assessing transurethral laser prostatectomy versus OSP were considered suitable for this meta-analysis, which included a total of 448 patients, with 232 patients undergoing laser and 216 patients undergoing OSP. Compared with OSP, although transurethral laser prostatectomy required a longer operative time (weighted mean difference (WMD) 27.49 mins; 95% confidence interval (CI) 16.54–38.44; P?<?0.00001) and obtained a less resected prostate weight (WMD ??11.72 g; 95% CI ??21.75 to ??1.70; P?=?0.02), patients undergoing laser prostatectomy benefited from significantly less hemoglobin decline (??0.97 g/dL; 95% CI ??1.31 to ??0.64; P?<?0.00001), shorter time of catheterization (WMD ??3.67 days; 95% CI ??5.60 to ??1.75; P?=?0.0002), shorter length of hospital stay (WMD ??4.75 days; 95% CI ??6.57 to ??2.93; P?<?0.00001), and less blood transfusion (odds ratio 0.10; 95% CI 0.03 to 0.35; P?=?0.0003). During postoperative follow-up, no significant difference was observed between the two groups in IPSS, QoL, Q_max, and PVR. Both transurethral laser prostatectomy and OSP are safe and effective for large prostates that require prostate resection. Taking into account of less blood loss, shorter catheterization time and hospital stay, and less blood transfusion, transurethral laser prostatectomy may be a better treatment for patients with large prostates.

     

经尿道等离子双极电刀前列腺剜除术治疗良性前列腺增生

目的:探讨经尿道等离子双极电刀前列腺剜除术治疗良性前列腺增生(BPH)的临床应用。方法:选择单纯BPH有手术指征患者90例,年龄59~83岁,平均71岁,随机分为2组,I组(50例)行经尿道前列腺电切术(TURP),Ⅱ组(40例)行经尿道等离子双极电刀前列腺剜除术(PKEP)。统计每例患者术前前列腺体积、国际前列腺症状(IPSS)评分、生活质量指数(QOL)评分和最大尿流率(Qm ax),手术时间,术中术后有无并发症、输血,术后有无膀胱持续冲洗及术后2周、术后6个月IPSS、QOL评分和Qm ax。结果:I组、II组术前前列腺体积平均为58.9、58.3 g;I组、II组手术时间平均为58.8、93.0 m in;I组患者中2例出现轻度电切综合征(TURS),II组患者术中术后心电监护未发现异常;术后行膀胱持续冲洗分别有3例、1例;术后导尿管拔除后出现急迫性尿失禁分别有4例;90例患者术中、术后均无输血。术前、术后2周、术后6个月IPSS评分I组平均分别为19.7分、11.6分、5.1分,II组平均分别为18.6分、8.4分、4.9分;QOL评分I组平均分别为4.6分、3.3分、1.1分,II组平均分别为4.5分、2.7分、1.1分;Qm ax I组平均分别为6.3、13.0、18.1 m l/s,II组平均分别为6.9、14.2、19.0 m l/s。两组间的手术时间、术后2周IPSS、QOL评分,各组内术前与术后6个月IPSS、QOL评分、Qm ax的差异有统计学意义(P<0.01)。两组间术前前列腺体积、术前IPSS、QOL评分和Qm ax、术后6个月IPSS、QOL评分及术后2周、术后6个月Qm ax的差异无统计学意义(P>0.05)。结论:PKEP可安全、有效、彻底治疗BPH,可作为手术治疗BPH的一种选择。     

经尿道前列腺绿激光汽化术与经膀胱前列腺切除术的近期疗效比较

目的:评价经尿道前列腺选择性绿激光汽化术(PVP)与经膀胱前列腺切除术的近期临床疗效。方法:将BPH患者60例随机分为两组,分别行经尿道前列腺选择性绿激光汽化术(PVP组)和耻骨上经膀胱前列腺切除术(开放手术组),比较两种术式的手术时间、术中出血量、近期疗效及并发症等情况。结果:两组术后前列腺国际症状评分(IPSS)、生活质量评分(QOL)、最大尿流率、剩余尿量均比术前明显改善(P<0.05),但两组上述指标之间比较差异无统计学意义(P>0.05)。PVP组平均手术时间(48.6±15.2min)、术中出血量(58.7±12.4ml)、术后膀胱冲洗时间(1.2±0.8d)、留置尿管时间(1.8±0.5d)、住院时间(4.5±1.2d)及近期并发症发生率明显小于开放手术组(P<0.05)。结论:PVP治疗BPH与耻骨上经膀胱前列腺切除术相比近期疗效相似,具有手术时间短、创伤小、出血少、恢复快、并发症发生率低等特点,是一种治疗BPH安全有效的理想微创术式。     

Photoselective vaporization of the prostate with GreenLight 120-W laser versus transurethral resection of the prostate for benign prostatic hyperplasia: a systematic review with meta-analysis of randomized controlled trials

The aim of this study is to assess the overall efficacy and safety of photoselective vaporization of the prostate (PVP) with GreenLight 120-W laser versus transurethral resection of the prostate (TURP) for treating patients of benign prostate hyperplasia (BPH) with lower urinary tract symptoms (LUTS). We performed a literature search of The Cochrane Library and the electronic databases, including Embase, Medline, and Web of Science. Manual searches were conducted of the conference proceedings, including European Association of Urology and American Urological Association (2007 to 2012). Outcomes reviewed included clinical baseline characteristics, perioperative data, complications, and postoperative functional results, such as postvoid residual (PVR), international prostate symptom score (IPSS), quality of life (QoL), and maximum flow rate (Q_max). Six randomized controlled trials (RCTs) were enrolled. Three hundred and forty-seven patients undergone 120-W PVP, and 350 patients were treated with TURP in the RCTs. There were no significant differences for clinical characteristics in these trials. In perioperative data, catheterization time and length of hospital stay were shorter in the PVP group. However, the operation time was shorter in the TURP group. Capsular perforation, blood transfusion, clot retention, and macroscopic hematuria were markedly less likely in PVP-treated subjects. The other complications between PVP and TURP did not demonstrate a statistic difference. There were no significant differences in QoL, PVR, IPSS, and Q_max in the 1, 3, 6, 12, and 24 months of postoperative follow-up. There was no significant difference at postoperation follow-up of functional outcomes including IPSS, PVR, Q_max, and QoL between the TURP-treated subjects and PVP-treated subjects. Owing to a shorter catheterization time, reduced hospital duration and less complication, PVP could be used as an alternative and a promising minimal invasive surgical procedure for the treatment of BPH.     

Transurethral enucleation of benign prostatic hyperplasia

A prostatic detaching blade for a new endoscopic method has been devised for transurethral resection of the prostate along the cleavage plane at the surgical capsule. After partial resection of the adenoma with the loop the remaining adenoma, except for a portion at the bladder neck, is detached from the surgical capsule under direct vision with the detaching blade. The remaining adenoma then is removed by the electric loop down to the detached surgical capsule. This method of resection has been performed in 200 patients with improvement of symptoms in all. Detachment of the adenoma along the surgical capsule always is possible, thereby defining the depth of resection and minimizing the risk of capsular perforation compared to standard transurethral prostatectomy.     

Transurethral holmium laser enucleation of the prostate compared with transvesical open prostatectomy: 18-month follow-up of a randomized trial

PURPOSE: This ongoing randomized study aims to find out whether transurethral holmium laser enucleation of the prostate (HoLEP) could be an alternative to open transvesical prostatectomy in patients with prostates >100 g. PATIENTS AND METHODS: A series of 120 urodynamically obstructed patients were randomized to HoLEP or open prostatectomy, 60 patients to each group. The HoLEP was performed with high-powered Ho:YAG lasers at 80 to 100 W (2.0 J, 40-50 Hz) and 550-nm bare laser fibers. The American Urological Association Symptom Scores, peak urinary flow rates, and postvoiding residual urine volumes were evaluated preoperatively and at 1, 3, 6, 12, and 18 months postoperatively. All complications were noted. RESULTS: By the Mann-Whitney test, there was no significant difference between the HoLEP and open surgery groups in patient age (69.0 years HoLEP v 71.0 years open surgery), prostate volume (115 cc [range 100-230 cc] v 113 cc [100-230 cc], or weight of resected tissue (94 g [range 57-220 g] v 96 g [range 61-220 g]). There were significant differences in the mean operative time (136 v 91 minutes; P< 0.0001), mean hemoglobin loss (1.9 v 2.8 g/dL; P< 0.0001), median catheter time (1 day v 6 days; P< 0.0001), and median hospital stay (2 days v 10 days; P< 0.0001). Both HoLEP and open prostatectomy resulted in pronounced and lasting postoperative improvements in Symptom Scores, peak urinary flow rates, and postvoiding residual volumes (P< 0.0001). The differences between HoLEP and open prostatectomy were not significant at any interval for any parameter. Blood transfusions were required in 0 HoLEP patients v 8 open surgery patients. Arterial bleeding occurred in three patients in each group. Secondary apical resection was required in two HoLEP patients and no open surgery patients. Bladder neck contracture occurred in none of the HoLEP patients and two of those having open surgery. Thus, the total number of patients having complications was 7 with HoLEP and 13 with open surgery. There were no deaths in either group. CONCLUSIONS: The HoLEP appears to be an endourologic alternative to open surgical enucleation of the prostate for large glands. It entails significantly less blood loss and a much shorter catheter time and hospital stay. The perioperative outcome strongly favors the holmium procedure. The rate of late complications is equally low with each procedure. The postoperative micturition improvement was significant and lasting and was equivalent in the two groups.     

Comparison between open simple prostatectomy and green laser enucleation of the prostate for treating large benign prostatic hyperplasia: a single-centre experience

Purpose

This study sought to compare perioperative outcomes and morbidities for open simple prostatectomy (OSP) and endoscopic green laser enucleation of the prostate (GreenLEP).

Methods

In a single department, all consecutive patients who underwent OSP between January 2005 and December 2010 were retrospectively reviewed, and all consecutive patients undergoing GreenLEP between July 2013 and January 2017 were prospectively enrolled. Perioperative data, information regarding early postoperative complications for up to 6 months and outcomes were collected and retrospectively compared.

Results

Overall, 204 patients were enrolled in each group. The baseline characteristics of patients in both groups were comparable. Intraoperative time was significantly longer for the OSP group than for the GreenLEP group (67 versus 60 min; p < 0.0001). The OSP group had significantly longer catheterisation (5 versus 2 days; p < 0.0001) and hospitalisation times (7 versus 2 days; p < 0.0001) than the GreenLEP group. The overall rate of complications was significantly higher after OSP than after GreenLEP (37.2 versus 20.6%; p = 0.0003); both Clavien–Dindo grade 3a complications (8.8 versus 0.98%) and Clavien–Dindo grade 3b complications (2.4 versus 3.4%) were observed. The transfusion rate was higher after OSP than after GreenLEP (8.3 versus 0.5%; p = 0.0001). The rehospitalisation rate was similar for both groups (7.8 versus 8.3%; p = 0.99).

Conclusions

The results of this single-centre cohort study confirm those of similar prior investigations addressing endoscopic enucleation of the prostate. Compared with OSP, GreenLEP may have a more desirable perioperative profile with lower morbidity. In contrast, GreenLEP and OSP were associated with similar 6-month rehospitalisation rates.

     

腔内整体剜除加耻骨上穿刺气膀胱下旋切在大体积前列腺增生治疗中的应用

目的:探讨经尿道腔内整体剜除加耻骨上穿刺气膀胱下旋切治疗大体积BPH的可行性、有效性和实用性。方法:应用尿道腔内整体剜除加耻骨上穿刺气膀胱下旋切治疗大体积BPH 26例,年龄62～85岁,前列腺体积80～165 ml。术中先用等离子电切环及镜鞘沿前列腺包膜剥离增生腺体,完整剜除后推入膀胱,前列腺窝彻底止血。耻骨上穿刺膀胱,插入旋切器,连接气腹机,在气膀胱下钳夹剜除的腺体,旋切成条状标本取出。结果:所有患者均顺利完成手术。手术时间32～54 min,平均41 min,术中出血量均少于60 ml。1例术后2 d内轻度水外渗,2例有轻微膀胱刺激征,术后2～4 d拔除膀胱造瘘管,6～9 d拔除导尿管。2例暂时性尿失禁,3～20 d后消失;23例获2～8个月随访。8例有射精史患者,均逆行射精,无尿道狭窄和其他并发症。手术前后国际前列腺症状评分(IPSS)[(26.2±2.4)分vs(6.5±2.2)分]、生活质量评分(QOL)[(4.6±1.2)分vs(1.4±0.9)分]、最大尿流率(Qmax)[(5.8±1.0)ml/s vs(19.6±2.8)ml/s]比较差异均有统计学意义(P均﹤0.01)。结论:经尿道腔内整体剜除加膀胱穿刺旋切治疗大体积BPH可行,可缩短手术时间,安全而有效。     

经尿道前列腺汽化电切术联合电切术与开放手术治疗前列腺增生症的围术期比较

目的对比研究经尿道前列腺汽化电切除术(transurethral electrovaporization of the prostate,TUVP)联合经尿道前列腺电切术(transurethral resection of the prostate,TURP)与开放性前列腺切除术治疗良性前列腺增生症(ben ign prostatehyperp lasia,BPH)的围术期情况。方法我院1997年11月~2004年12月手术治疗BPH 156例,其中TUVP联合TURP 53例,耻骨上前列腺切除术103例。结果2组手术时间无显著性差异(90±70 m in vs 108±68 m in,t=-1.550,P=0.123),TUVP联合TURP组输血率(8%vs 38%,2χ=16.109,P=0.000),尿液转清时间(2±1 d vs 4±1 d,t=-11.831,P=0.000),术后带尿管时间(10±8 d vs 19±10 d,t=-5.680,P=0.000),术后下床活动时间(6±4 d vs 20±10 d,t=-9.785,P=0.000),术后住院时间(20±14 d vs 34±24 d,t=-3.914,P=0.000)均优于开放组,但并发症发生率高(15.1%vs 2.9%,2χ=6.173,P=0.013)。结论TUVP联合TURP治疗BPH创伤小,术后恢复快,是一种良好的手术方式。     

Transurethral plasmakinetic resection of the prostate is a reliable minimal invasive technique for benign prostate hyperplasia: a meta-analysis of randomized controlled trials

To evaluate the efficacy and safety of plasmakinetic resection of the prostate (PKRP) versus transurethral resection of the prostate (TURP) for the treatment of patients with benign prostate hyperplasia (BPH), a meta-analysis of randomized controlled trials was carried out. We searched PubMed, Embase, Web of Science and the Cochrane Library. The pooled estimates of maximum flow rate, International Prostate Symptom Score, operation time, catheterization time, irrigated volume, hospital stay, transurethral resection syndrome, transfusion, clot retention, urinary retention and urinary stricture were assessed. There was no notable difference in International Prostate Symptom Score between TURP and PKRP groups during the 1-month, 3 months, 6 months and 12 months follow-up period, while the pooled Q_max at 1-month favored PKRP group. PKRP group was related to a lower risk rate of transurethral resection syndrome, transfusion and clot retention, and the catheterization time and operation time were also shorter than that of TURP. The irrigated volume, length of hospital stay, urinary retention and urinary stricture rate were similar between groups. In conclusion, our study suggests that the PKRP is a reliable minimal invasive technique and may anticipatorily prove to be an alternative electrosurgical procedure for the treatment of BPH.     

经尿道半导体激光前列腺剜除术与前列腺电切术治疗不同体积良性前列腺增生的临床对比分析

目的:对比分析经尿道半导体激光前列腺剜除术(DIOD)与前列腺电切术(TURP)治疗不同体积良性前列腺增生(BPH)的临床疗效。方法:回顾性分析2012年3月至2015年8月本院收治的256例BPH患者,其中141例采用DIOD,115例采用TURP。术前按前列腺体积大小分为3组,<60 ml组中42例行DIOD术,31例行TURP术;60~80 ml组中51例行DIOD术,45例行TURP术;>80 ml组中48例行DIOD术,39例行TURP术;对比分析3组患者两种治疗方法的临床疗效,各组围手术期平均手术时间、血红蛋白变化率、Na+变化率、膀胱冲洗时间、留置尿管时间,以及术前术后血清PSA、IPSS评分、最大尿流率(Qmax)、残余尿(PVR)等指标变化。结果:<60 ml组围手术期各项指标及术后随访指标在两种手术方法间无明显差异;60~80 ml组中DIOD组血红蛋白变化[(3.25±1.53)g/L]、Na+变化[(3.58±1.27)mmol/L]、冲洗时间[(30.06±6.22)h]、留置尿管时间[(47.61±13.55)h]明显优于TURP组[(4.77±1.67)g/L、(9.67±2.67)mmol/L、(58.32±10.25)h、(68.01±9.69)h](P<0.05),DIOD组术后PSA下降大于TURP组[(2.34±1.29)μg/L vs(1.09±0.72)μg/L,P<0.05];>80 ml组中DIOD组术后PSA下降大于TURP组[(3.35±1.39)μg/L vs(1.76±0.91)μg/L,P<0.05)],且围手术期各项指标明显优于TURP组(P<0.05或P<0.01)。DIOD组无输血、经尿道电切综合征、尿道狭窄等并发症发生,但假性尿失禁发生率高于TURP组(22.70%vs 7.83%)(P<0.01)。结论:DIOD治疗BPH短期疗效确切,具有出血少、恢复快、安全性高的特点。在中、大体积前列腺中优势明显,而对小体积前列腺与TURP疗效相当。     

Efficacy and safety of Chinese herbal medicine for benign prostatic hyperplasia: systematic review of randomized controlled trials

Chinese herbal medicine is commonly used as a treatment for benign prostatic hyperplasia (BPH), but its efficacy and safety remain to be examined. To compare the efficacy and adverse events of Chinese herbal medicine alone or used adjuvantly with Western medications for BPH. Two independent reviewers searched the major electronic databases for randomized controlled trials comparing Chinese herbal medicine, either in single or adjuvant use with Western medication, with placebo or Western medication. Relevant journals and grey literature were also hand-searched. The outcome measures included changes in urological symptoms, urodynamic measures, prostate volume and adverse events. The frequency of commonly used herbs was also identified. Out of 13 922 identified citations of publications, 31 studies were included. Eleven studies with a Jadad score ≥3 were selected for meta-analysis. Chinese herbal medicine was superior to Western medication in improving quality of life and reducing prostate volume. The frequency of adverse events in Chinese herbal medicine was similar to that of placebo and less than that of Western medication. The evidence is too weak to support the efficacy of Chinese herbal medicine for BPH due to the poor methodological quality and small number of trials included. The commonly used herbs identified here should provide insights for future clinical practice and research. Larger randomized controlled trials of better quality are needed to truly evaluate the efficacy of Chinese herbal medicine.     

HoLEP与TUPKP治疗BPH的安全性和疗效的meta分析

目的:系统评价经尿道钬激光前列腺剜除术(Ho LEP)与经尿道前列腺等离子双极电切术(TUPKP)治疗良性前列腺增生(BPH)的安全性及疗效。方法:计算机检索Pub Med、SCI、Ovid、The Cochrane Library、CNKI、CBM、VIP及万方数据库,全面收集有关Ho LEP与TUPKP比较治疗BPH的临床对照试验,检索时限为2000年1月至2016年4月。由2名评价者按照纳入与排除标准选择试验、提取资料和评价质量后,采用Rev Man 5.3软件进行meta分析。结果:纳入7篇研究,共2031例患者。Meta分析结果显示:与TUPKP组相比,Ho LEP组手术时间较长[WMD=24.61,95%CI(11.88,37.34),P0.001],住院时间短[WMD=-1.91,95%CI(-3.74,-0.07),P=0.04],膀胱冲洗时间短[WMD=-21.50,95%CI(-34.95,-8.06),P=0.002],留置导尿时间短[WMD=-27.60,95%CI(-48.17,-7.03),P=0.009],血红蛋白丢失量更少[WMD=-0.42,95%CI(-0.78,-0.07),P=0.02],术后3个月残余尿量(PVR)较少[WMD=-3.35,95%CI(-4.46,-2.23),P﹤0.01],术后6个月残余尿量(PVR)较少[WMD=-1.11,95%CI(-2.18,-0.05),P=0.04],术后12个月后最大尿流率(Qmax)速率较大[WMD=0.42,95%CI(0.04,0.80),P=0.03],Ho LEP组尿路刺激症状较少[OR=0.58,95%CI(0.41,0.81),P=0.002],而切除组织重量、血清钠下降、尿道狭窄、ED、逆行射精、短暂性尿失禁,术后1、3、12个月的生活质量评分(Qo L),术后1、3、6、12个月的国际前列腺症状评分(IPSS),术后1、3、6个月的最大尿流率(Qmax),术后6个月的国际勃起功能指数评分(IIEF-5)差异均无统计学意义(P0.05)。结论:Ho LEP组术后12个月的Qmax较大,术后3、6个月的PVR减少,围手术期安全性高、恢复快,尿路刺激症状发生率较低方面优于TUPKP,建议在临床推广应用。由于纳入研究数量和质量存在局限性,尚需要大样本、多中心、前瞻性、高质量的随机对照研究进一步验证。     

经尿道钬激光前列腺剜除术治疗BPH的Meta分析

目的:用Meta分析的方法评价经尿道钬激光前列腺剜除术(HoLEP)和经尿道前列腺电切术(TURP)/开放手术(OP)治疗良性前列腺增生(BPH)所致膀胱出口梗阻(BOO)的疗效和安全性. 方法:计算机检索Medline、Cochrane临床对照试验中心数据库、Embase、万方数据库和中国生物医学文献数据库,手工检索...