Holmium laser enucleation of the prostate versus transurethral resection of the prostate in treatment of benign prostatic hyperplasia: A meta-analysis of 13 randomized control trials.

Abstract

Background: The prevalence of benign prostatic hyperplasia (BPH) in older men increases with age, beginning at 40-45 years and reaching to 60% by 60 years and 80% by 80 years. Surgical procedures such as holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP) are the preferred treatments for BPH. Nevertheless, there is disagreement regarding the most efficient and safe treatment for BPH. The objective of this meta-analysis was to assess the efficacy and safety of HoLEP and TURP based on existing evidence.

Materials and methods: This meta-analysis was performed in accordance with the PRISMA guidelines. In February 2023, a literature review was conducted using PubMed, ScienceDirect, and the Cochrane Library, and the meta-analysis was performed using RevMan V.5.4.

Results: A total of 656 patients underwent HoLEP, and 653 patients underwent TURP. There was no statistically significant difference in the International Prostate Symptom Score at 1 month or at 3, 6, 18, 24, and 36 months; the HoLEP group showed a significant difference at 12 months. The pooled data from the maximum urinary flow rate at 1-12 months revealed no significant findings, but the TURP group showed significant results at 24 months. Meanwhile, the HoLEP group showed significant postvoid residual results. There was no significant difference in the quality of life between the groups. Patients who underwent HoLEP had shorter hospital stay and catheter usage period and had lower hemoglobin drop. The operating time was shorter in the TURP group. The difference in specimen weight between the 2 groups was not statistically significant. The overall complications were similar in both groups, but the HoLEP group received significantly fewer blood transfusions.

Conclusions: Holmium laser enucleation of the prostate demonstrated excellent efficacy and safety, with fewer hematological changes and complications; however, TURP had a shorter operating time.