Holmium Laser Enucleation of the Prostate Versus Transurethral Resection of the Prostate: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objectives: To evaluate the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) versus transurethral resection of the prostate (TURP) for relief of bladder outlet obstruction (BOO) on benign prostatic hyperplasia (BPH). Methods: A systematic literature search for randomized controlled trials (RCTs) comparing HoLEP and TURP in several databases from 1996 to 2011 were performed. Meta-analysis was conducted with the Review Manager Software. Results: Of 248 potential citations, 6 RCTs were included into our meta-analysis. There was no significant difference between the two groups in the maximum urinary flow rate (Qmax) and international prostate symptom score (IPSS) at 1 month (p = 0.41 and p = 0.87) or 6 months (p = 0.07 and p = 0.37) after treatment. However, at 12 months postoperatively, the Qmax and IPSS in the HoLEP group were significantly better than those in the TURP group (p < 0.0001 and p = 0.01). The results also suggested a benefit of HoLEP over TURP in blood loss (p = 0.001), catheterization time (p < 0.0001), hospital stay (p = 0.001), and blood transfusion rate (p = 0.04), while the results favored TURP over HoLEP for operative time (p = 0.001) and the incidence of postoperative dysuria (p = 0.003). Conclusions: Comparing with TURP, HoLEP showed slightly better postoperative results in Qmax and IPSS during 12-month follow-up, as well as significantly better perioperative results and similarly low complication rates. However, the operative time and the incidence of postoperative dysuria favor TURP. Generally, HoLEP is a promising minimal invasive alternative to TURP for treatment of BPH.