World J Mens Health.  2016 Aug;34(2):110-122. 10.5534/wjmh.2016.34.2.110.

A Systematic Review and Meta-Analysis of Functional Outcomes and Complications Following the Photoselective Vaporization of the Prostate and Monopolar Transurethral Resection of the Prostate

Affiliations
  • 1Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea. joouro@yuhs.ac
  • 2Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing monopolar transurethral resection of the prostate (MTURP) and photoselective vaporization of the prostate (PVP) in order to provide the most up-to-date and reliable recommendations possible.
MATERIALS AND METHODS
Relevant RCTs were identified from electronic databases for meta-analysis of the surgical outcomes and complications of MTURP and PVP. Meta-analytical comparisons were made using qualitative and quantitative syntheses. The outcome variables are presented as odds ratios with 95% confidence intervals (CIs).
RESULTS
In total, 11 articles were included in this comparative analysis of PVP versus MTURP. Most of the recently published studies exhibited low risk in terms of quality assessment. MTURP was superior to PVP regarding operative time; however, with regard to catheterization and hospitalization time, the mean differences were -1.39 (95% CI=-1.83~-0.95, p<0.001) and -2.21 (95% CI=-2.73~-1.69, p<0.001), respectively, in favor of PVP. PVP was superior to MTURP with regard to transfusion rate and clot retention, but no statistically significant differences were found with regard to acute urinary retention and urinary tract infection. The long-term complications of bladder neck contracture and urethral stricture showed no statistically significant differences between PVP and MTURP. Long-term functional outcomes, including the International Prostate Symptom Score and maximum flow rate, likewise did not display statistically significant differences between PVP and MTURP.
CONCLUSIONS
Based on our findings, we believe that PVP should be considered as an alternative surgical procedure for treating male lower urinary tract symptoms secondary to benign prostatic hyperplasia.

Keyword

Lasers; Meta-analysis; Prostatic hyperplasia; Transurethral resection of prostate

MeSH Terms

Catheterization
Catheters
Contracture
Hospitalization
Humans
Lower Urinary Tract Symptoms
Male
Neck
Odds Ratio
Operative Time
Prostate*
Prostatic Hyperplasia
Transurethral Resection of Prostate
Urethral Stricture
Urinary Bladder
Urinary Retention
Urinary Tract Infections
Volatilization*

Figure

  • Fig. 1 Flow diagram of screened, excluded, and analyzed publications. Based on the inclusion and exclusion criteria, 11 articles were excluded after a simple reading of the titles and abstracts of the articles, and two articles were excluded due to the patient population.

  • Fig. 2 Methodological quality graph. Two researchers' judgments about each methodological quality item are presented as percentages across all included studies. Two trials exhibited a moderate risk of bias for all quality criteria and all others were classified as having a low risk of bias.

  • Fig. 3 Funnel plots. Egger's regression intercept tests demonstrated that catheterization time showed evidence of publication bias (p<0.001), whereas the other variables had no evidence of publication bias. (A) Operation time. (B) Hospitalization time. (C) Catheterization time. (D) Transfusion rate. (E) Acute urinary retention. (F) Clot retention. (G) Urinary tract infection. (H) Bladder neck contracture. (I) Urethral stricture. (J) International Prostate Symptom Score. (K) Maximum flow rate. SE: standard error, MD: mean difference, OR: odds ratio.

  • Fig. 4 Forest plots comparing operation time (A), catheterization time (B), and hospitalization time between PVP and MTURP (C). With regard to operative time, the forest plot using the random effect model showed a MD of 12.89 (95% CI=7.09~18.70, p<0.001) in favor of MTURP. However, the MDs for catheterization and hospitalization time were -1.39 (95% CI=-1.83~-0.95, p<0.001) and -2.21 (95% CI=-2.73~-1.69, p<0.001), respectively, in favor of PVP. PVP: photoselective vaporization of the prostate, MTURP: monopolar transurethral resection of the prostate, SD: standard deviation, CI: confidence interval, MD: mean difference, W: weight.

  • Fig. 5 Forest plots of transfusion rates (A), acute urinary retention (B), clot retention (C), and urinary tract infection comparing PVP and MTURP (D). Superior results were found for PVP regarding transfusion rates (OR=0.17, 95% CI=0.08~0.37, p<0.001) and clot retention (OR=0.10, 95% CI=0.03~0.27, p<0.001), but no statistically significant differences were found for acute urinary retention and urinary tract infection. PVP: photoselective vaporization of the prostate, MTURP: monopolar transurethral resection of the prostate, OR: odds ratio, CI: confidence interval, W: weight.

  • Fig. 6 Forest plots comparing bladder neck contracture (A) and urethral stricture between PVP and MTURP (B). No statistically significant differences were found. PVP: photoselective vaporization of the prostate, MTURP: monopolar transurethral resection of the prostate, OR: odds ratio, CI: confidence interval, W: weight.

  • Fig. 7 Forest plots comparing long-term functional outcomes, including IPSS (A) and Qmax (B). No differences were found between PVP and MTURP. IPSS: International Prostate Symptom Score, PVP: photoselective vaporization of the prostate, MTURP: monopolar transurethral resection of the prostate, SD: standard deviation, MD: mean difference, CI: confidence interval, W: weight, Qmax: maximum flow rate.

  • Fig. 8 Galbraith's radial plots. Most variables demonstrated little heterogeneity after selecting the effect models for each variable. (A) Operation time. (B) Hospitalization time. (C) Catheterization time. (D) Transfusion rate. (E) Acute urinary retention. (F) Clot retention. (G) Urinary tract infection. (H) Bladder neck contracture. (I) Urethral stricture. (J) International Prostate Symptom Score. (K) Maximum flow rate.


Cited by  2 articles

Letter to the editor: Urethral strictures after bipolar transurethral resection of prostate may be linked to slow resection rate
Yu Seob Shin, Jong Kwan Park
Investig Clin Urol. 2018;59(1):66-67.    doi: 10.4111/icu.2018.59.1.66.

Changes in Erectile Function after Photoselective Vaporization of the Prostate with a 120-W GreenLight High-Performance System Laser: 2-Year Follow-Up
Juhyun Park, Sung Yong Cho, Min Chul Cho, Hyeon Jeong, Hwancheol Son
World J Mens Health. 2017;35(3):156-162.    doi: 10.5534/wjmh.17027.


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