首页良性前列腺增生治疗及预后证据详情

Transurethral endoscopic enucleation of the prostate using a diode laser versus bipolar plasmakinetic for benign prostatic obstruction: a meta-analysis

原文:2020年 发布于 Lasers Med Sci 35卷 第5期 1159-1169 浏览量:993次 原文链接

作者: Xiao K. W. Zhou L. He Q. Chen G. Gao X. S. Liu Y. Li H. Wang K. J.

作者单位: Institute of Urology (Laboratory of Reconstructive Urology), Department of Urology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China. Institute of Urology (Laboratory of Reconstructive Urology), Department of Urology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China. wangkj@scu.edu.cn.

归属分类: 良性前列腺增生治疗及预后证据

DOI: 10.1007/s10103-020-02949-9

关键词: Aged Clinical Trials as Topic Humans Lasers Semiconductor Male Postoperative Complications/etiology Postoperative Period Prostatic Hyperplasia Publication Bias Quality of Life Risk *Transurethral Resection of Prostate Treatment Outcome Bhp Diode laser Enucleation Meta-analysis Plasmakinetic

文献简介

To evaluate the clinical efficacy and safety of diode laser enucleation of the prostate (DiLEP) versus bipolar plasma kinetic enucleation of the prostate (PKEP) in the management of benign prostatic hyperplasia (BPH). A systematic literature search was undertaken using PubMed, Embase, Web of Science, Cochrane Library, and CKNI databases to identify eligible studies published before April 2019. The quality of evidence and methodology was assessed. Primary outcomes were clinical and demographic characteristics and postoperative efficacy including maximum flow rate (Qmax), postvoid residual (PVR), quality of life (QoL), and International Prostate Symptom Score (IPSS); secondary outcomes were intraoperative variables and major complications. Meta-analyses of extracted data were performed with the RevMan version 5.2. The overall effects were determined by the Z-test, and a p value less than 0.05 was considered with significant difference. A fixed- or random-effect model was chosen to fit the pooled heterogeneity (determined by Chi-squared test and I(2)). As qualified trials were few, subgroup analyses were not performed. Four randomized controlled trials (RCTs) involving 451 patients were enrolled in our meta-analysis. In the included trials, all the diode (wavelength at 980 nm and 1470 nm) lasers applied output at continuous wave mode; the energy settings ranged from 120 to 160 W for enucleation and 30 to 60 W for coagulation. DiLEP provided less perioperative hemoglobin decrease (MD = - 3.22; 95% CI (- 5.15, - 1.29); p = 0.001; I(2) = 65%), less postoperative catheterization time (MD = - 17.82; 95% CI (- 32.74, - 2.90); p = 0.02; I(2) = 96%), less postoperative irrigation time (MD = - 7.15; 95% CI (- 13.67, - 0.62); p = 0.03; I(2) = 98%), and lower incidence of urinary irritative symptoms (OR = 0.31; 95% CI (0.14, 0.67); p = 0.003; I(2) = 0%) compared with PKEP. During the 1, 3, 6, and 12-month postoperative follow-up, no statistically significant difference was found in Qmax, IPSS, QoL, and PVR between the procedures. As regards other perioperative and postoperative parameters and major complications, we found no significant difference. Both DiLEP and PKEP are safe and efficient methods for the treatment of BPH. However, DiLEP showed less perioperative hemoglobin decrease, less postoperative catheterization time, less postoperative irrigation time, and lower rates of postoperative irritative symptoms compared with the PKEP group.

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