Holmium Laser Enucleation versus Transurethral Resection in Patients with Benign Prostate Hyperplasia: An Updated Systematic Review with Meta-Analysis and Trial Sequential Analysis

Background: Holmium laser enucleation (HoLEP) in surgical treatment of benign prostate hyperplasia (BPH) potentially offers advantages over transurethral resection of the prostate (TURP). Methods: Published randomized controlled trials (RCTs) were identified from PubMed, EMBASE, Science Citation Index, and the Cochrane Library up to October 10, 2013 (updated on February 5, 2014). After methodological quality assessment and data extraction, meta-analysis was performed using STATA 12.0 and Trial Sequential Analysis (TSA) 0.9 software. Results: Fifteen studies including 8 RCTs involving 855 patients met the criteria. The results of meta-analysis showed that: a) efficacy indicators: there was no significant difference in quality of life between the two groups (P.0.05), but compared with the TURP group, Qmax was better at 3 months and 12 months, PVR was less at 6, 12 months, and IPSS was lower at 12 months in the HoLEP, b) safety indicators: compared with the TURP, HoLEP had less blood transfusion (RR 0.17, 95 % CI 0.06 to 0.47), but there was no significant difference in early and late postoperative complications (P.0.05), and c) perioperative indicators: HoLEP was associated with longer operation time (WMD 14.19 min, 95 % CI 6.30 to 22.08 min), shorter catheterization time (WMD 219.97 h, 95 % CI 224.24 to 215.70 h) and hospital stay (WMD 225.25 h, 95 % CI 229.81 to 2 20.68 h). Conclusions: In conventional meta-analyses, there is no clinically relevant difference in early and late postoperativ