The University of Southampton
University of Southampton Institutional Repository

Holmium laser enucleation versus simple prostatectomy for treating large prostates: Results of a systematic review and meta-analysis

Holmium laser enucleation versus simple prostatectomy for treating large prostates: Results of a systematic review and meta-analysis
Holmium laser enucleation versus simple prostatectomy for treating large prostates: Results of a systematic review and meta-analysis
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 (Qmax) 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 Qmax, 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 (< 0.001). However, with HoLEP there was significantly less blood loss (< 0.001), patients had a shorter hospital stay (= 0.03), and were catheterised for significantly fewer hours (= 0.01). There were no significant differences in the total number of complications recorded amongst HoLEP and OP (= 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.
Journal Article, Review
2090-598X
50-58
Jones, Patrick
d27beb5b-0e09-4ed5-89f0-6c62421c2397
Alzweri, Laith
6abd45e7-63d9-4116-9b5a-d6f699aed377
Rai, Bhavan Prasad
e1156207-bfd1-4f89-b0aa-9e55fc54235b
Somani, Bhaskar K
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Bates, Chris
d334f2d8-b937-4561-a6d4-6d9ff87ac291
Aboumarzouk, Omar M
3c7e2433-638d-4378-9931-902fdc68acce
Jones, Patrick
d27beb5b-0e09-4ed5-89f0-6c62421c2397
Alzweri, Laith
6abd45e7-63d9-4116-9b5a-d6f699aed377
Rai, Bhavan Prasad
e1156207-bfd1-4f89-b0aa-9e55fc54235b
Somani, Bhaskar K
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Bates, Chris
d334f2d8-b937-4561-a6d4-6d9ff87ac291
Aboumarzouk, Omar M
3c7e2433-638d-4378-9931-902fdc68acce

Jones, Patrick, Alzweri, Laith, Rai, Bhavan Prasad, Somani, Bhaskar K, Bates, Chris and Aboumarzouk, Omar 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), 50-58. (doi:10.1016/j.aju.2015.10.001).

Record type: Review

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 (Qmax) 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 Qmax, 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 (< 0.001). However, with HoLEP there was significantly less blood loss (< 0.001), patients had a shorter hospital stay (= 0.03), and were catheterised for significantly fewer hours (= 0.01). There were no significant differences in the total number of complications recorded amongst HoLEP and OP (= 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.

Text
Holmium laser enucleation - Version of Record
Download (57kB)

More information

Accepted/In Press date: 17 October 2015
e-pub ahead of print date: 26 November 2015
Published date: March 2016
Keywords: Journal Article, Review

Identifiers

Local EPrints ID: 419253
URI: https://eprints.soton.ac.uk/id/eprint/419253
ISSN: 2090-598X
PURE UUID: 687ce718-6dbf-4f65-880e-33d09b2637e0

Catalogue record

Date deposited: 09 Apr 2018 16:30
Last modified: 18 Nov 2019 18:15

Export record

Altmetrics

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of https://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×