Efficacy and Safety of Holmium Laser Prostatectomy: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

LIU Jianjun ¹ , WU Taixiang ² , YANG Yuru ¹ , WEI Qiang ¹

1.Department of Urology; West China Hospital; Sichuan University; Chengdu 610041; China2.Chinese Cochrane Center; West China Hospital; Sichuan University; Chengdu 610041; China;

Corresponding author：

Keywords：

Holmium laser; Benign prostatic hyperplasia; Systematic review; Randomized controlled trial

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Objective 　To access the efficacy and safety of Holmium laser prostatectomy technique compared to TURP.
Methods 　We searched MEDLINE (1996 to 2004), EMBASE (1984 to 2004), The Cochrane Library (Issue 4, 2004), CNKI, VIP, CMCC and CBMdisc; and handsearched the relevant Chinese journals. Randomized controlled trials (RCT) were included. The quality of trials was evaluated and meta-analysis was performed. Non-randomized controlled trials were also included to evaluate the safety and efficacy.
Results 　We found 4 randomized controlled trials. A total of 480 participants were in the trials ranging from 60 to 200. There was no statistical difference between the two techniques at 12 or 48 months follow-up in terms of quality of life (QOL) improvement（WMD=-0.19, 95%CI -0.81 to 0.44, Z=0.59, P=0.56; WMD=-0.30, 95%CI -0.90 to 0.30, Z=0.98, P=0.33); Qmax improvement（WMD=1.63 ml/s, 95%CI -0.32 to 3.59, Z=1.64, P=0.10; WMD=3.80 ml/s, 95%CI -1.36 to 8.96,Z=1.44, P=0.15); I-PSS or AUA (WMD=-0.06, 95%CI -1.01 to 0.89, Z=0.12, P=0.91; WMD=-1.40, 95%CI -3.91 to 1.11, Z=1.09, P=0.27) and the urethral stricture complication rate (RR=0.75, 95%CI 0.35 to 1.60, Z=0.74, P=0.46). However hospital stay was significantly shorter in the Holmium laser prostatectomy groups (total WMD=-24.89, 95%CI -28.56 to -21.21, Z=13.27, P＜0.000 01). We can not draw consistent conclusions in terms of blood loss according to the present data. One study indicated Holmium laser prostatectomy technique was more cost-effective than TURP.
Conclusions 　In short period Holmium laser prostatectomy is as safe as TURP in terms of hospital stay, urethral stricture and blood loss complication. This new technique is as effiective as TURP in terms of I-PSS (AUA), Qmax and QOL. More RCTs and more long term follow-up is necessary.

Citation： LIU Jianjun,WU Taixiang,YANG Yuru,WEI Qiang. Efficacy and Safety of Holmium Laser Prostatectomy: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2005, 05(5): 375-380. doi: Copy

1.	沈文浩, 熊恩庆, 宋波. 钬激光前列腺剜除术与经尿道前列腺电切术的近期疗效比较[J]. 临床泌尿外科杂志, 2004; 19(3): 262～265.
2.	杨永英, 刘军红, 毛永贤, 王亚琴. 钬激光与电切术治疗前列腺增生效果比较[J]. 护理学杂志, 2003; 19(3): 52～53.
3.	杜传军, 白福鼎, 陈继民, 裘益青, 经霄, 罗尉, 顾才校. 前列腺钬激光剜除术与电切术安全性及疗效比较[J]. 中华泌尿外科杂志, 2004; 25(6): 627～630.
4.	Gilling PJ, Cass CB, Malcom A, Cresswell, Fraundorfer MR, Kabalin JN. Holmium laser prostatectomy of the prostate versus Nd:YAG visual laser a randomized prospective compurison of two techniques for laser prostatectomy[J]. Urology, 1998; 51(4): 573-577.
5.	Mebust MK, Holtgrewe HL, Cockett ATK, Peters PJ, and Wriling Committee. Transurethral prostatectomy: immediate and postoperative complications. A cooperative study of 13 participating institutions evaluating 3,885 patients[J]. J Urol, 1989; 141(2): 243-247.
6.	Shen WH, Xiong EQ, Song B. An evaluation of the prostate and transurethral resection of the prostate for the treatment of symptomatic BPH[J]. Journal of Clinical Urology, 2004; 19(3): 262-265.
7.	Yang YY, Liu JH, Mao YX, Wang YQ. Comparison between HolRP and TURP in the treatment of prostate hyperplasia[J]. Journal of Nursing Science, 2003; 19(4): 52-53.
8.	Naspro R, Freschi AS, Guazzoni G, Girolamo VD, Scattoni RCV, Rigatti P and Montorsi F. Holmium laser enucleation versus transurthral resection of the prostate are histological findings comparable[J]? J Urol, 2004; 171(3): 1203-1206.
9.	Du CJ, Bai FD, Chen JM, Qiu YQ, Jing X, Luo W, Gu CX. A comparative study of the efficacy and safety of holmium laser enucleation of the prostate VS transurethral resection of the prostate[J]. Chin J Urol, 2004; 25(6): 627-630.
10.	Stephenson AJ, Savard J, Morehouse DD, TaguchiY and Elhilali MM. Holmium laser enucleation of the prostate with tissue morcellator: the new gold-standard for the treatment of benign prostatic hyperplasia[J]. J Urol, 2001; 165(suppl): 293, abstract 1207.
11.	Das A, Kennett KM, Sutton T, Fraundorfer MR and Gilling PJ. Histologic effects of holmium: YAG laser resection versus transurethral resection of the prostate[J]. J Endourol, 2000; 14(5): 459-462.
12.	Hammad FT, Mark SD, Davidson PJ, Gowland SP, Gordon B and English SF. Holmium: YAG laser resectin versus transurethral resection of the prostate: a randomized prospective trial with 1-year follow-up[J]. ANZ J Surg, 2002; 72(3): A138.
13.	Kitagawa M, Furuse H, Fukuta K and Aso Y. A randomized study comparing holmium laser resection of the prostate to transurethral resection or the prostate[J]. Br J Urol, 1997; 80(suppl 2): 209.
14.	Westenberg A, Gilling P, Kennett k, Frampton C, and Fraundorfer M. Holmium laser resection of the prostate versus transurethral resection of the prostate: resection of a randomized trial with 4-year minimum long-term follow up[J]. J Urol, 2004; 172(2): 616-619.
15.	Gilling PJ, Kennett KM, and Fraundorfer MR. Holmium laser resection v transurethral resection of the prostate: results of a randomized trial with 2 years of follow-up[J]. J Endourol, 2000; 14(9): 757-760.
16.	Gilling PJ, Mackey M, Cresswell M, Kennett K, Kabalin JN, Fraundorfer MR. Holmiun laser versus transurethral resection of the prostate: a randomized prospective trial with 1-year follow up[J]. J Urol, 1999; 162(5): 1640-1644.
17.	Fraundorfer MR, Gilling PJ, Kennett KM, Dunton NG. Holmium laser resection of the prostate is more cost effective than transurethral resection of the prostate: results of a randomized prospective study[J]. Urology, 2001; 57(7): 454-458.
18.	Kuntz RM, Ahyrin S, Lehrich K, Fayad A. Transurethral holmium laser enucliation of the prostate versus transurethral electrocautery resection of the prostate: a randomized prospective trial in 200 patients[J]. J Urol, 2004; 172(3): 1012-1016.
19.	Kuntz RM, Lehrich K, Fayad A. Transurethral holmium laser enucleation of the prostate (HoLEP) compared to traditional transurethral resection of the prostate (TURP) for prostates smaller than 100 grams: a randomized prospective clinical trial[J]. J Endourol, 2001; 15(Suppl): A41, abstract A5-P7.
20.	Tan AH, Gilling PJ, Kennett KM, Franmpton C, Westenberg AM, Fraundorfer MR. A randomized trial comparing Holmium laser enucleation of the prostate with transurethral resection of the prostate for the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia in large glands (40 to 200 grams)[J]. J Urol, 2003; 170(4 Pt 1): 1270-1274.
21.	Gilling, PJ, Cass CB, Cresswell MD, Malcolm AR, Fraundorfer MR. The use of the holmium laser in the treatment of benign prostatic hyperplasia[J]. J Endourol, 1996; 10(5): 459-461.
22.	Montorsi M, Naspro R, Salonia A, Suardi N, Briganti A, Zanoni M, Valenti S, Vavassori I, Rigatti P. Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center, prospective benign prostatic hyperplasia[J]. J Urol, 2004; 172: 1926-1929.

1. 沈文浩, 熊恩庆, 宋波. 钬激光前列腺剜除术与经尿道前列腺电切术的近期疗效比较[J]. 临床泌尿外科杂志, 2004; 19(3): 262～265.
2. 杨永英, 刘军红, 毛永贤, 王亚琴. 钬激光与电切术治疗前列腺增生效果比较[J]. 护理学杂志, 2003; 19(3): 52～53.
3. 杜传军, 白福鼎, 陈继民, 裘益青, 经霄, 罗尉, 顾才校. 前列腺钬激光剜除术与电切术安全性及疗效比较[J]. 中华泌尿外科杂志, 2004; 25(6): 627～630.
4. Gilling PJ, Cass CB, Malcom A, Cresswell, Fraundorfer MR, Kabalin JN. Holmium laser prostatectomy of the prostate versus Nd:YAG visual laser a randomized prospective compurison of two techniques for laser prostatectomy[J]. Urology, 1998; 51(4): 573-577.
5. Mebust MK, Holtgrewe HL, Cockett ATK, Peters PJ, and Wriling Committee. Transurethral prostatectomy: immediate and postoperative complications. A cooperative study of 13 participating institutions evaluating 3,885 patients[J]. J Urol, 1989; 141(2): 243-247.
6. Shen WH, Xiong EQ, Song B. An evaluation of the prostate and transurethral resection of the prostate for the treatment of symptomatic BPH[J]. Journal of Clinical Urology, 2004; 19(3): 262-265.
7. Yang YY, Liu JH, Mao YX, Wang YQ. Comparison between HolRP and TURP in the treatment of prostate hyperplasia[J]. Journal of Nursing Science, 2003; 19(4): 52-53.
8. Naspro R, Freschi AS, Guazzoni G, Girolamo VD, Scattoni RCV, Rigatti P and Montorsi F. Holmium laser enucleation versus transurthral resection of the prostate are histological findings comparable[J]? J Urol, 2004; 171(3): 1203-1206.
9. Du CJ, Bai FD, Chen JM, Qiu YQ, Jing X, Luo W, Gu CX. A comparative study of the efficacy and safety of holmium laser enucleation of the prostate VS transurethral resection of the prostate[J]. Chin J Urol, 2004; 25(6): 627-630.
10. Stephenson AJ, Savard J, Morehouse DD, TaguchiY and Elhilali MM. Holmium laser enucleation of the prostate with tissue morcellator: the new gold-standard for the treatment of benign prostatic hyperplasia[J]. J Urol, 2001; 165(suppl): 293, abstract 1207.
11. Das A, Kennett KM, Sutton T, Fraundorfer MR and Gilling PJ. Histologic effects of holmium: YAG laser resection versus transurethral resection of the prostate[J]. J Endourol, 2000; 14(5): 459-462.
12. Hammad FT, Mark SD, Davidson PJ, Gowland SP, Gordon B and English SF. Holmium: YAG laser resectin versus transurethral resection of the prostate: a randomized prospective trial with 1-year follow-up[J]. ANZ J Surg, 2002; 72(3): A138.
13. Kitagawa M, Furuse H, Fukuta K and Aso Y. A randomized study comparing holmium laser resection of the prostate to transurethral resection or the prostate[J]. Br J Urol, 1997; 80(suppl 2): 209.
14. Westenberg A, Gilling P, Kennett k, Frampton C, and Fraundorfer M. Holmium laser resection of the prostate versus transurethral resection of the prostate: resection of a randomized trial with 4-year minimum long-term follow up[J]. J Urol, 2004; 172(2): 616-619.
15. Gilling PJ, Kennett KM, and Fraundorfer MR. Holmium laser resection v transurethral resection of the prostate: results of a randomized trial with 2 years of follow-up[J]. J Endourol, 2000; 14(9): 757-760.
16. Gilling PJ, Mackey M, Cresswell M, Kennett K, Kabalin JN, Fraundorfer MR. Holmiun laser versus transurethral resection of the prostate: a randomized prospective trial with 1-year follow up[J]. J Urol, 1999; 162(5): 1640-1644.
17. Fraundorfer MR, Gilling PJ, Kennett KM, Dunton NG. Holmium laser resection of the prostate is more cost effective than transurethral resection of the prostate: results of a randomized prospective study[J]. Urology, 2001; 57(7): 454-458.
18. Kuntz RM, Ahyrin S, Lehrich K, Fayad A. Transurethral holmium laser enucliation of the prostate versus transurethral electrocautery resection of the prostate: a randomized prospective trial in 200 patients[J]. J Urol, 2004; 172(3): 1012-1016.
19. Kuntz RM, Lehrich K, Fayad A. Transurethral holmium laser enucleation of the prostate (HoLEP) compared to traditional transurethral resection of the prostate (TURP) for prostates smaller than 100 grams: a randomized prospective clinical trial[J]. J Endourol, 2001; 15(Suppl): A41, abstract A5-P7.
20. Tan AH, Gilling PJ, Kennett KM, Franmpton C, Westenberg AM, Fraundorfer MR. A randomized trial comparing Holmium laser enucleation of the prostate with transurethral resection of the prostate for the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia in large glands (40 to 200 grams)[J]. J Urol, 2003; 170(4 Pt 1): 1270-1274.
21. Gilling, PJ, Cass CB, Cresswell MD, Malcolm AR, Fraundorfer MR. The use of the holmium laser in the treatment of benign prostatic hyperplasia[J]. J Endourol, 1996; 10(5): 459-461.
22. Montorsi M, Naspro R, Salonia A, Suardi N, Briganti A, Zanoni M, Valenti S, Vavassori I, Rigatti P. Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center, prospective benign prostatic hyperplasia[J]. J Urol, 2004; 172: 1926-1929.

Chinese Journal of Evidence-Based Medicine

Efficacy and Safety of Holmium Laser Prostatectomy: A Systematic Review

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