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

Invited Review
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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

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

Notes

Acknowledgements

This work was supported by grants from the National Nature Science Foundation of China (No. 81400755).

Author’s contribution

Deng and Sun: project development, data collection, data analysis, and manuscript writing. These two first authors contributed equally to this meta-analysis. Zhu, Zhuo, and Zhao: data analysis. Xia, Han, and Hermann: project development

Compliance with ethical standards

Ethical approval

All included studies have reported institutional ethical approval.

Research involving human participants and/or animals

All included studies involving human participants.

Conflict of interest

No competing financial interests exist.

Informed consent

Formal consent is not required for meta-analysis.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Urology, Shanghai First People’s Hospital, School of MedicineShanghai Jiao Tong UniversityShanghaiChina
  2. 2.Department of Urology and Urological OncologyHanover Medical School (MHH)HanoverGermany

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