10 This instrument is not dependent on prostate size, and tissue can be preserved for histology.8 Systematic meta-analysis and large series support the place of HoLEP as a safe and effective alternative to TURP and OP.
Several randomized clinical trials (RCTs) have compared HoLEP with TURP and OP, with the main findings given in Table 1. Table 1 Efficacy of HoLEP and PVP Efficacy Tan and colleagues11 performed a meta-analysis of the available RCTs comparing HoLEP with TURP. At 6 and 12 months after treatment, the weighted mean difference (WMD) for peak urinary flow rate (Qmax) was 1.06 and 0.59 mL/s, respectively, favoring HoLEP, but did not reach statistical significance. In this meta-analysis, Inhibitors,research,lifescience,medical HoLEP was superior to TURP with regard to catheterization time (17.7–31.0 h vs 43.4–57.8 h, respectively; P < .001), and hospital stay (27.6–59.0 vs 48.3–85.5 days; P = .001). In contrast, TURP was superior to HoLEP with regard to the duration of operation (33.1–73.8 vs 62.1–94.6 Inhibitors,research,lifescience,medical h, respectively; P = .001). Lourenco and associates12 observed that HoLEP improved symptom score during the entire follow-up period of up to 30 months, with larger mean changes
in postoperative measurements. Inhibitors,research,lifescience,medical However, the differences in the individual studies were not statistically significant (WMD −0.82; 95% confidence interval [CI], −1.76-0.12; P = .09). In the same meta-analysis, the same result was found for Qmax at 12-month follow-up. Compared with TURP, significantly higher Qmax rates were reported for HoLEP (WMD 1.48 mL/s; 95% CI, 0.58–2.40; P = .002). According to Inhibitors,research,lifescience,medical another meta-analysis, the reduction in International Prostate Symptom Score (IPSS) and the increase
in Qmax were significantly more pronounced after HoLEP than after TURP. As a consequence, HoLEP is the only endoscopic procedure to date with proven superior efficacy compared with TURP.13 In this meta-analysis, operation time was significantly Panobinostat manufacturer longer compared with Inhibitors,research,lifescience,medical TURP. Interestingly, when comparing mean tissue retrieval rates (grams per minute) of HoLEP and TURP within the analyzed studies, there was no significant difference (0.52 g/min vs 0.57 g/min), suggesting that the two procedures are equally (time) efficient. Two randomized trials comparing HoLEP with OP for large prostates reported equivalent improvements these in symptoms and Qmax rates but significantly longer operating time for HoLEP.14,15 Kuntz and colleagues14 found that there was no statistically significant difference between the HoLEP and OP groups with regard to the American Urological Association Symptom Score (AUASS) (3.0 vs 3.0), Qmax (24.3 mL/s vs 24.4 mL/s), and PVR volume (10.6 mL vs 5.3 mL) 5 years after surgery. The perioperative outcomes favored HoLEP, as demonstrated by a significantly lower transfusion rate (0% vs 13.3%), shorter length of catheterization (LOC; 30 h vs 194 h), and shorter hospital stay (70 h vs 250 h).
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