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Asian Journal of Andrology (2012) 14, 720–725; doi:10.1038/aja.2012.56; published online 20 August 2012
Photoselective green-light laser vaporisation vs. TURP for BPH: meta-analysis
Hui Ding1,*, Wan Du2,*, Ze-Ping Lu1, Zhen-Xing Zhai1, Han-Zhang Wang3 and Zhi-Ping Wang1
1 Institute of Urology, Key Laboratory of Urological Diseases in Gansu Province, Gansu Nephro-Urological Clinical Center, The Second Hospital of Lanzhou University, Lanzhou 730000, China
2 Otolaryngological Department, The Second Hospital of Lanzhou University, Lanzhou 730000, China
3 The Medical College of Shandong University, Jinan 250000, China
Correspondence: Dr ZP Wang, (erywzp@lzu.edu.cn)
* These authors contributed equally to this work.
Received 15 February 2012; Revised 10 April 2012; Accepted 26 April 2012
Advance online publication 20 August 2012.
| Abstract |
This study sought to evaluate the efficacy and safety of photoselective vaporisation (PVP) vs. transurethral resection of the prostate (TURP) for patients with benign prostatic hyperplasia (BPH). Eligible studies were identified from electronic databases (Cochrane Library, PubMed and EMBASE). The database search, quality assessment and data extraction were performed independently by two reviewers. Efficacy (primary outcomes: maximum urinary flow rate (Qmax), international prostate symptom score (IPSS), postvoid residual urine (PVR) and quality of life (QoL); secondary outcomes: operative time, hospital time and catheter removal time) and safety (complications, such as transfusion and capsular perforation) were explored by using Review Manager 5.0. Six randomized controlled trials (RCTs) and five case-controlled studies of 1398 patients met the inclusion criteria. A meta-analysis of the extractable data showed that there were no differences in IPSS, Qmax, QoL or PVR between PVP and TURP (mean difference (MD): prostate sizes <70 ml, Qmax at 24 months, MD=0.01, P=0.97; IPSS at 12 months, MD=0.18, P=0.64; QoL at 12 months, MD=−0.00, P=0.96; PVR at 12 months, MD=0.52, P=0.43; prostate sizes >70 ml, Qmax at 6 months, MD=−3.46, P=0.33; IPSS at 6 months, MD=3.11, P=0.36; PVR at 6 months, MD=25.50, P=0.39). PVP was associated with a shorter hospital time and catheter removal time than TURP, whereas PVP resulted in a longer operative time than TURP. For prostate sizes <70 ml, there were fewer transfusions, capsular perforations, incidences of TUR syndrome and clot retentions following PVP compared with TURP. These results indicate that PVP is as effective and safe as TURP for BPH at the mid-term patient follow-up, in particular for prostate sizes <70 ml. Due to the different energy settings available for green-light laser sources and the higher efficiency and performance of higher-quality lasers, large-sample, long-term RCTs are required to verify whether different energy settings affect outcomes.
Keywords: benign prostatic hyperplasia (BPH); meta-analysis; photoselective vaporisation; transurethral resection of the prostate (TURP) |
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