Thulium laser VapoResection of the prostate versus traditional transurethral resection of the prostate or transurethral plasmakinetic resection of prostate for benign prostatic obstruction: a systematic review and meta-analysis

World J Urol. 2018 Sep;36(9):1355-1364. doi: 10.1007/s00345-018-2287-6. Epub 2018 Apr 12.

Abstract

Purpose: To compare the efficacy and safety of thulium laser VapoResection of the prostate (ThuVaRP) versus standard traditional transurethral resection of the prostate (TURP) or plasmakinetic resection of prostate (PKRP) for benign prostatic obstruction.

Methods: Systematic searches were performed in the Medline, EMBASE, the Cochrane Library, Web of Science, and CNKI in December 2017. The outcomes of demographic and clinical characteristics, perioperative variables, complications, and postoperative efficacy including International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), and postvoid residual (PVR) were assessed.

Results: 16 studies were selected in the meta-analysis including nine randomized controlled trials (RCTs) and seven non-RCTs. Among of them, nine studies compared ThuVaRP with PKRP, while seven studies compared ThuVaRP with TURP. It seemed that ThuVaRP needed longer operation time than TURP (WMD = 6.41, 95% CI 1.38-11.44, p = 0.01) and PKRP (WMD = 10.15, 95% CI 5.20-15.10, p < 0.0001). ThuVaRP was associated with less serum hemoglobin decreased, catheterization time, and the length of hospital stay compared with TURP (WMD = - 0.58, 95% CI - 0.77 to 0.38, p < 0.00001; WMD = - 1.89, 95% CI - 2.67 to 1.11, p < 0.00001; WMD = - 2.25, 95% CI - 2.91 to 1.60, p < 0.00001) and PKRP (WMD = - 0.28, 95% CI - 0.46 to 0.10, p = 0.002; WMD = - 1.88, 95% CI - 2.87 to 0.89, p = 0.0002; WMD = - 2.08, 95% CI - 2.63 to 1.54, p<0.00001). According to our assessment, there was no significantly difference in postoperative efficacy.

Conclusions: The pooled data indicated that ThuVaRP had a nearly efficacy to TURP and PKRP based on IPSS, QoL, Qmax, and PVR. Although ThuVaRP was associated with longer operation time, it got distinct superiority on serum hemoglobin decreased, catheterization time, and hospital stay.

Keywords: 2-micron; Benign prostatic obstruction,; Plasmakinetic resection of prostate,; Safety and efficacy; Thulium laser VapoResection of the prostate,; Thulium laser,; Transurethral resection of the prostate,.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Humans
  • Laser Coagulation / methods*
  • Laser Therapy / methods*
  • Lasers, Solid-State
  • Male
  • Non-Randomized Controlled Trials as Topic / statistics & numerical data
  • Prostatic Hyperplasia / complications
  • Prostatic Hyperplasia / surgery*
  • Quality of Life
  • Randomized Controlled Trials as Topic / statistics & numerical data
  • Thulium*
  • Transurethral Resection of Prostate / methods*
  • Treatment Outcome
  • Ureteral Obstruction / etiology
  • Ureteral Obstruction / surgery*

Substances

  • Thulium