Role of Thulium Laser and Holmium Laser in the Surgical Treatment of Benign Prostatic Hyperplasia: A Systemic Review and Meta-Analysis
Abstract
Background: Patients with benign prostatic hyperplasia are generally treated holmium laser enucleation of the prostate (HoLEP) and thulium laser enucleation of the prostate (ThuLEP). Therefore, it is important to analyze the several surgical procedures used for benign prostatic hyperplasia in terms of their role, effectiveness and safety.
Methods: We conducted a meta-analysis by searching databases of PubMed, Google Scholar, and Web of Science. Finally, we selected 10 papers including 2,456 patients treated with of thulium laser and holmium laser in the surgical treatment of benign prostatic hyperplasia. We did the analysis using RevMan 5.0 with the selected studies until 26 October 2023.
Results: ThuLEP resulted in a smaller reduction in haemoglobin (MD: -0.22, 95%CI -0.32 to -0.13, P<0.001) and a shorter hospital stay (MD: -0.29, 95%CI -0.38 to -0.20, P <0.001). During the postoperative follow-ups, only the IPSS (MD: -0.03; 95%CI -0.11 to -0.06; P 0.58) at the six-month showed statistically significant differences.
Conclusion: ThuLEP has greater security and faster growth than HoLEP.
1. Vartak KP, Raghuvanshi K (2019). Outcome of thulium laser enucleation of prostate surgery in high-risk patients with benign prostatic hyperplasia. Urol Ann, 11(4): 358-362.
2. Chughtai B, Forde JC, Thomas DD, et al (2016). Benign prostatic hyperplasia. Nat Rev Dis Primers, 2:16031.
3. Gazel E, Kaya E, Yalcin S, Aybal HC, Ay-dogan TB, Tunc L (2019). Comparison of the efficacy of holmium laser enu-cleation of the prostate in treating pros-tate volumes of 80 mL. Urol Int, 102(3):306e-310.
4. Gratzke C, Bachmann A, Descazeaud A, et al (2015). EAU guidelines on the assess-ment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol, 67(6):1099-1109.
5. Becker B, Netsch C, Glybochko P, Rapoport L, Taratkin M, Enikeev D (2018). A feasibility study utilizing the thulium and holmium laser in patients for the treatment of recurrent benign prostatic hyperplasia after previous prostatic surgery. Urol Int, 101(2):212-218.
6. Rieken M, Bachmann A (2014). Laser treatment of benign prostate enlarge-ment– which laser for which prostate? Nat Rev Urol, 11(3):142-152.
7. Gilling PJ (2020). HoLEP is the complete technique for treating BPH. BJU Int, 126(1):3.
8. Gilling PJ, Kennett KM, Fraundorfer MR (2000). Holmium laser enucleation of the prostate for glands larger than 100 g: an endourologic alternative to open prosta-tectomy. J Endourol, 14(6):529-31.
9. Zell MA, Abdul-Muhsin H, Navaratnam A, et al (2021). Holmium laser enucleation of the prostate for very large benign prostatic hyperplasia (≥ 200 cc). World J Urol, 39(1):129-134.
10. Naspro R, Gomez Sancha F, Manica M, et al (2017). From "gold standard" resec-tion to reproducible "future standard" endoscopic enucleation of the prostate: what we know about anatomical enucle-ation. Minerva Urol Nefrol, 69(5):446-458.
11. Sun F, Sun X, Shi Q, Zhai Y (2018). Tran-surethral procedures in the treatment of benign prostatic hyperplasia: a systemat-ic review and meta-analysis of effec-tiveness and complications. Medicine (Bal-timore), 97(51):e13360.
12. Barbalat Y, Velez MC, Sayegh CI, Chung DE (2016). Evidence of the efficacy and safety of the thulium laser in the treat-ment of men with benign prostatic ob-struction. Ther Adv Urol, 8(3):181-191.
13. Herrmann TR, Bach T, Imkamp F, et al (2010). Thulium laser enucleation of the prostate (ThuLEP): transurethral ana-tomical prostatectomy with laser sup-port. Introduction of a novel technique for the treatment of benign prostatic obstruction. World J Urol, 28(1):45-51.
14. Castellani D, Pirola GM, Pacchetti A, Saredi G, Dellabella M (2020). State of the art of thulium laser enucleation and vapoenucleation of the prostate: a sys-tematic review. Urology, 136:19-34.
15. MJ, McKenzie JE, Bossuyt PM, Boutron I, et al (2021). The PRISMA 2020 statement: an updated guideline for reporting sys-tematic reviews. BMJ, 372:n71.
16. Cuschieri S (2019). The STROBE guide-lines. Saudi J Anaesth, 13(Suppl 1):S31-S34.
17. Stang A. (2010). Critical evaluation of the Newcastle-Ottawa scale for the assess-ment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 25(9):603-605.
18. Clark HD, Wells GA, Huet C, et al. (1999). Assessing the quality of randomized tri-als: reliability of the Jadad scale. Control Clin Trials, 20(5): 448-452.
19. Enikeev D, Glybochko P, Okhunov Z, et al (2018). Retrospective Analysis of Short-Term Outcomes After Monopolar Ver-sus Laser Endoscopic Enucleation of the Prostate: A Single Center Experi-ence. J Endourol, 32(5):417-423.
20. Pirola GM, Saredi G, Codas Duarte R, et al (2018). Holmium laser versus thulium la-ser enucleation of the prostate: a matched-pair analysis from two centers. Ther Adv Urol, 10(8):223-233.
21. Popov SV, Orlov IN, Martov AG, et al (2019). [A comparison between enuclea-tion of the prostate using holmium and thulium laser in volume over 80 cc: ret-rospective clinical study with 12-months follow-up]. Urologiia, (3):80-83.
22. Zhang F, Shao Q, Herrmann TR, et al (2012). Thulium laser versus holmium la-ser transurethral enucleation of the prostate: 18-month follow-up data of a single center. Urology, 79(4):869-874.
23. Zhang J, Ou Z, Zhang X, He W, et al (2020). Holmium laser enucleation of the pros-tate versus thulium laser enucleation of the prostate for the treatment of large-volume prostates > 80 ml: 18-month fol-low-up results. World J Urol, 38(6):1555-1562.
24. Shao Q, Zhang FB, Shang DH, Tian Y (2009). (Comparison of holmium and thulium laser in transurethral enuclea-tion of the prostate). Zhonghua Nan Ke Xue, 15(4):346-9.
25. Bozzini G, Berti L, Aydoğan TB, et al (2021). A prospective multicenter ran-domized comparison between Holmium Laser Enucleation of the Prostate (HoLEP) and Thulium Laser Enuclea-tion of the Prostate (ThuLEP). World J Urol, 39(7):2375-2382.
26. Kaya E, Yılmaz S, Açıkgöz O, et al (2021). Laser enucleation for prostates larger than 100 mL: Comparison of HoLEP and ThuLEP. Andrologia, 53(8):e14125.
27. Ghobrial FK, El-Tabey N, El-Hefnawy AS, et al (2021). Holmium laser versus thuli-um laser versus bipolar enucleation of the prostate for treatment of large sized benign prostatic enlargement. Prelimi-nary report of a randomized controlled trial. Eur Urol, 79:S111–S112.
28. Feng L, Zhang D, Tian Y, Song J (2016). Thulium laser enucleation versus plas-makinetic enucleation of the prostate: a randomized trial of a single center. J Endourol, 30(6):665-670.
29. Rausch S, Heider T, Bedke J, Kruck S, et al (2015). Analysis of early morbidity and functional outcome of thulium: yttrium-aluminum-garnet laser enucleation for benign prostate enlargement: patient age and prostate size determine adverse surgical outcome. Urology, 85(1):182-8.
30. Scoffone CM, Cracco CM (2020). Prostate enucleation, better with low or high-power holmium laser? A systematic review. Arch Esp Urol, 73(8):745-752.
31. Rivera ME, Lingeman JE, Heinsimer K, et al (2018). A survey of morcellator preference and cost comparison of the lumenis VersaCut and wolf Piranha morcellators. Urology, 111:54-58.
32. Netsch C, Bach T, Herrmann TRW, Gross AJ (2012). Thulium:YAG VapoEnucleation of the prostate in large glands: a prospective comparison using 70- and 120-W 2- mm lasers. Asian J Androl, 14(2):325-329.
33. Kumar A (2023). Meta-analysis in Clinical Research: Principles and Procedures. First edition. Springer Nature. pp. 1-119.
34. Srivastava R, and Kumar A (2021). Use of aspirin in reduction of mortality of COVID‐19 patients: A meta‐analysis. Int J Clin Pract, 75(11): e14515.
35. Noor A, Latha S, and Kumar A (2023). Safety and efficacy of monoclonal antibodies targeting IL-5 in severe eosinophilic asthma: A Systematic review and meta-analysis of randomized controlled trials. Health Sciences Review,8:100103.
36. Thakur M, Datusalia AK and Kumar A (2022). Use of steroids in COVID-19 patients: A meta-analysis. Eur J Pharmacol, 914: 174579.
37. Vitalakumar D, Sharma A, Kumar A and Flora SJS (2021). Neurological manifestations in COVID-19 patients: a meta-analysis. ACS Chem Neurosci, 12 (15): 2776–2797.
38. Singh R K (2023). A meta-analysis of the impact on gastrectomy versus endoscop-ic submucosal dissection for early stom-ach cancer. International Journal of Clinical Medical Research, 1(3):11.
39. Singh AK, Vidyadhari A, Singh H, et al (2022). Role of colchicine in the management of COVID-19 patients: A meta-analysis of cohort and randomized controlled trials. Clin Epidemiol Glob Health, 16: 101097.
2. Chughtai B, Forde JC, Thomas DD, et al (2016). Benign prostatic hyperplasia. Nat Rev Dis Primers, 2:16031.
3. Gazel E, Kaya E, Yalcin S, Aybal HC, Ay-dogan TB, Tunc L (2019). Comparison of the efficacy of holmium laser enu-cleation of the prostate in treating pros-tate volumes of 80 mL. Urol Int, 102(3):306e-310.
4. Gratzke C, Bachmann A, Descazeaud A, et al (2015). EAU guidelines on the assess-ment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol, 67(6):1099-1109.
5. Becker B, Netsch C, Glybochko P, Rapoport L, Taratkin M, Enikeev D (2018). A feasibility study utilizing the thulium and holmium laser in patients for the treatment of recurrent benign prostatic hyperplasia after previous prostatic surgery. Urol Int, 101(2):212-218.
6. Rieken M, Bachmann A (2014). Laser treatment of benign prostate enlarge-ment– which laser for which prostate? Nat Rev Urol, 11(3):142-152.
7. Gilling PJ (2020). HoLEP is the complete technique for treating BPH. BJU Int, 126(1):3.
8. Gilling PJ, Kennett KM, Fraundorfer MR (2000). Holmium laser enucleation of the prostate for glands larger than 100 g: an endourologic alternative to open prosta-tectomy. J Endourol, 14(6):529-31.
9. Zell MA, Abdul-Muhsin H, Navaratnam A, et al (2021). Holmium laser enucleation of the prostate for very large benign prostatic hyperplasia (≥ 200 cc). World J Urol, 39(1):129-134.
10. Naspro R, Gomez Sancha F, Manica M, et al (2017). From "gold standard" resec-tion to reproducible "future standard" endoscopic enucleation of the prostate: what we know about anatomical enucle-ation. Minerva Urol Nefrol, 69(5):446-458.
11. Sun F, Sun X, Shi Q, Zhai Y (2018). Tran-surethral procedures in the treatment of benign prostatic hyperplasia: a systemat-ic review and meta-analysis of effec-tiveness and complications. Medicine (Bal-timore), 97(51):e13360.
12. Barbalat Y, Velez MC, Sayegh CI, Chung DE (2016). Evidence of the efficacy and safety of the thulium laser in the treat-ment of men with benign prostatic ob-struction. Ther Adv Urol, 8(3):181-191.
13. Herrmann TR, Bach T, Imkamp F, et al (2010). Thulium laser enucleation of the prostate (ThuLEP): transurethral ana-tomical prostatectomy with laser sup-port. Introduction of a novel technique for the treatment of benign prostatic obstruction. World J Urol, 28(1):45-51.
14. Castellani D, Pirola GM, Pacchetti A, Saredi G, Dellabella M (2020). State of the art of thulium laser enucleation and vapoenucleation of the prostate: a sys-tematic review. Urology, 136:19-34.
15. MJ, McKenzie JE, Bossuyt PM, Boutron I, et al (2021). The PRISMA 2020 statement: an updated guideline for reporting sys-tematic reviews. BMJ, 372:n71.
16. Cuschieri S (2019). The STROBE guide-lines. Saudi J Anaesth, 13(Suppl 1):S31-S34.
17. Stang A. (2010). Critical evaluation of the Newcastle-Ottawa scale for the assess-ment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 25(9):603-605.
18. Clark HD, Wells GA, Huet C, et al. (1999). Assessing the quality of randomized tri-als: reliability of the Jadad scale. Control Clin Trials, 20(5): 448-452.
19. Enikeev D, Glybochko P, Okhunov Z, et al (2018). Retrospective Analysis of Short-Term Outcomes After Monopolar Ver-sus Laser Endoscopic Enucleation of the Prostate: A Single Center Experi-ence. J Endourol, 32(5):417-423.
20. Pirola GM, Saredi G, Codas Duarte R, et al (2018). Holmium laser versus thulium la-ser enucleation of the prostate: a matched-pair analysis from two centers. Ther Adv Urol, 10(8):223-233.
21. Popov SV, Orlov IN, Martov AG, et al (2019). [A comparison between enuclea-tion of the prostate using holmium and thulium laser in volume over 80 cc: ret-rospective clinical study with 12-months follow-up]. Urologiia, (3):80-83.
22. Zhang F, Shao Q, Herrmann TR, et al (2012). Thulium laser versus holmium la-ser transurethral enucleation of the prostate: 18-month follow-up data of a single center. Urology, 79(4):869-874.
23. Zhang J, Ou Z, Zhang X, He W, et al (2020). Holmium laser enucleation of the pros-tate versus thulium laser enucleation of the prostate for the treatment of large-volume prostates > 80 ml: 18-month fol-low-up results. World J Urol, 38(6):1555-1562.
24. Shao Q, Zhang FB, Shang DH, Tian Y (2009). (Comparison of holmium and thulium laser in transurethral enuclea-tion of the prostate). Zhonghua Nan Ke Xue, 15(4):346-9.
25. Bozzini G, Berti L, Aydoğan TB, et al (2021). A prospective multicenter ran-domized comparison between Holmium Laser Enucleation of the Prostate (HoLEP) and Thulium Laser Enuclea-tion of the Prostate (ThuLEP). World J Urol, 39(7):2375-2382.
26. Kaya E, Yılmaz S, Açıkgöz O, et al (2021). Laser enucleation for prostates larger than 100 mL: Comparison of HoLEP and ThuLEP. Andrologia, 53(8):e14125.
27. Ghobrial FK, El-Tabey N, El-Hefnawy AS, et al (2021). Holmium laser versus thuli-um laser versus bipolar enucleation of the prostate for treatment of large sized benign prostatic enlargement. Prelimi-nary report of a randomized controlled trial. Eur Urol, 79:S111–S112.
28. Feng L, Zhang D, Tian Y, Song J (2016). Thulium laser enucleation versus plas-makinetic enucleation of the prostate: a randomized trial of a single center. J Endourol, 30(6):665-670.
29. Rausch S, Heider T, Bedke J, Kruck S, et al (2015). Analysis of early morbidity and functional outcome of thulium: yttrium-aluminum-garnet laser enucleation for benign prostate enlargement: patient age and prostate size determine adverse surgical outcome. Urology, 85(1):182-8.
30. Scoffone CM, Cracco CM (2020). Prostate enucleation, better with low or high-power holmium laser? A systematic review. Arch Esp Urol, 73(8):745-752.
31. Rivera ME, Lingeman JE, Heinsimer K, et al (2018). A survey of morcellator preference and cost comparison of the lumenis VersaCut and wolf Piranha morcellators. Urology, 111:54-58.
32. Netsch C, Bach T, Herrmann TRW, Gross AJ (2012). Thulium:YAG VapoEnucleation of the prostate in large glands: a prospective comparison using 70- and 120-W 2- mm lasers. Asian J Androl, 14(2):325-329.
33. Kumar A (2023). Meta-analysis in Clinical Research: Principles and Procedures. First edition. Springer Nature. pp. 1-119.
34. Srivastava R, and Kumar A (2021). Use of aspirin in reduction of mortality of COVID‐19 patients: A meta‐analysis. Int J Clin Pract, 75(11): e14515.
35. Noor A, Latha S, and Kumar A (2023). Safety and efficacy of monoclonal antibodies targeting IL-5 in severe eosinophilic asthma: A Systematic review and meta-analysis of randomized controlled trials. Health Sciences Review,8:100103.
36. Thakur M, Datusalia AK and Kumar A (2022). Use of steroids in COVID-19 patients: A meta-analysis. Eur J Pharmacol, 914: 174579.
37. Vitalakumar D, Sharma A, Kumar A and Flora SJS (2021). Neurological manifestations in COVID-19 patients: a meta-analysis. ACS Chem Neurosci, 12 (15): 2776–2797.
38. Singh R K (2023). A meta-analysis of the impact on gastrectomy versus endoscop-ic submucosal dissection for early stom-ach cancer. International Journal of Clinical Medical Research, 1(3):11.
39. Singh AK, Vidyadhari A, Singh H, et al (2022). Role of colchicine in the management of COVID-19 patients: A meta-analysis of cohort and randomized controlled trials. Clin Epidemiol Glob Health, 16: 101097.
| Files | ||
| Issue | Vol 53 No 3 (2024) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v53i3.15131 | |
| Keywords | ||
| Benign prostatic hyperplasia Holmium laser Thulium laser Treatment | ||
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How to Cite
1.
Wang J, Wu S, Wang M. Role of Thulium Laser and Holmium Laser in the Surgical Treatment of Benign Prostatic Hyperplasia: A Systemic Review and Meta-Analysis. Iran J Public Health. 2024;53(3):495-507.
