Background Traditional meta-analyses or systematic reviews of randomized controlled trials (RCTs) have been used to compare laser surgeries and transurethral resection of the prostate (TURP) for benign prostate hyperplasia (BHP), but they cannot provide a hierarchy regarding efficacy and safety of treatment Objective We therefore performed a network meta-analysis (NMA) to compare and create hierarchies for efficacy and safety of TUPR and laser surgeries for BPH Materials and methods We searched for reports of RCTs published up to April 25, 2015 After methodological quality assessment and data extraction, we performed an NMA to compare TURP and laser surgeries for BPH Results We ranked the treatments of TURP and laser surgeries for BPH For IPSS at 6 months, holmium laser resection of the prostate (HoLRP) ranked the first-best and at 12 months, holmium laser enucleation of the prostate (HoLEP) For Qmax at 6 and 12 months, HoLEP ranked the first-best; for operative time it was TURP; for cathedral removal time, diode laser enucleation of the prostate (DiLEP) ranked the first-best Conclusions Although TURP is considered the gold standard for treating BPH, it is not better in terms of efficacy and safety compared with the laser surgery Our NMA created hierarchies for the 9 types of surgery in terms of efficacy and safety, which should help clinicians choose the best approach for the individual patient

http://journal.waocp.org/article_38747_1f4a42e9d43f4e82d687d58535d1eb3d.pdf

Efficacy and Safety of Laser Surgery and Transurethral Resection of the Prostate for Treating Benign Prostate Hyperplasia: a Network Meta-analysis.

Purpose: The objective of this study was to retrospectively investigate postoperative infectious complications (PICs) in our early experience with holmium laser enucleation of the prostate (HoLEP) followed by mechanical morcellation for symptomatic benign prostatic hyperplasia. Materials and Methods: A retrospective review was performed of the clinical data for 90 consecutive patients who underwent HoLEP at our institution between February 2008 and March 2011. All patients were evaluated for the emergence of PICs, including prophylactic antibiotic administration (PAA) and the influence of the kind or duration of PAA on PIC. The details of cases with PICs were also examined. Results: The patients’ mean age was 71 years (range, 50 to 95 years), and their mean prostate volume was 60 mL (range, 2 to 250 mL). There were 7 cases (7.78%) with PICs; in detail, 3 patients were diagnosed with prostatitis, 2 with pyelonephritis, and 2 with epididymitis. Three patients had positive urine cultures: 1 had Serratia marcescens/Proteus mirabilis, 1 had S. marcescens, and 1 had Klebsiella pneumonia; only one case had urological sepsis. Our statistical data showed no significant differences between 2 or fewer days and 3 or more days of PAA and PIC occurrence. There was also no significant effect on PIC occurrence of sulbactam/ampicillin compared with other antibiotics. Conclusions: The results of this retrospective study showed that PIC occurrence did not depend on the duration or the kind of PAA. Further prospective study is necessary for the evaluation and establishment of prophylactic measures for PICs.

/pdf/postoperative-infectious-complications-in-our-early-39ky09lkuj.pdf

Postoperative infectious complications in our early experience with holmium laser enucleation of the prostate for benign prostatic hyperplasia.

Surgical management of lower urinary tract symptoms secondary to benign prostatic hypertrophy

Resume L’hyperplasie benigne de la prostate est un etat de la nature plus qu’une maladie en elle-meme. Elle concerne principalement les hommes de plus de 50 ans et pose un probleme de sante publique. Une revue de la litterature a ete realisee a partir d’une selection d’articles du plus haut niveau de preuve sur la prise en charge therapeutique de l’hyperplasie benigne de la prostate. Le traitement medical repose sur la phytotherapie, les alpha-bloquants et les inhibiteurs de la 5-alpha-reductase. Le traitement chirurgical est, lui, discute devant une hyperplasie de prostate compliquee ou devant un echec du traitement medical bien conduit. Les options chirurgicales sont nombreuses. La resection endoscopique de prostate et l’adenomectomie par voie ouverte sont les interventions de reference. Du fait d’une morbidite non negligeable, d’autres procedures moins invasives ont ete developpees recemment. Le choix du traitement dependra alors du volume prostatique, de son anatomie et des comorbidites.

Actualités sur la prise en charge de l’hyperplasie bénigne de la prostate. Quel adénome traiter et comment ?

Objective To evaluate the effectiveness and safety of holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP)/open prostatectomy (OP) in the treatment of bladder outlet obstruction (BOO) secondary to benign prostatic hyperplasia (BPH). Methods We searched Medline, Cochrane Library, Embase, Wanfang and CBM for randomized controlled trials (RCT) comparing HoLEP with TURP/OP. Comparable data were extracted from eligible studies and pooled for meta-analysis using RevMan5.1. Results Nine RCTs were included in this study, 6 comparing HoLEP with TURP, and the other 3 comparing HoLEP with OP. Meta-analysis showed that, compared with TURP, HoLEP was associated with shorter hospital stay and catheterization time, less hemoglobin loss, longer operative time, and better improvement in international prostate symptom score (IPSS) , peak urinary flow rate (Qmax) and post void residual (PVR) , but the incidences of postoperative urethral stricture and urinary incontinence had no statistically significant difference between the two. Compared with OP, HoLEP showed shorter hospital stay and catheterization time, a lower rate of blood transfusion, longer operative time, and removal of fewer tissues, but the two procedures exhibited no significant differences in either the improvement of IPSS and Qmax or the incidence of urethral stricture. Conclusion HoLEP is a minimally invasive technique, safe and highly effective for the treatment of BOO secondary to BPH, with its advantages of lower peri-operative morbidity and faster recovery over TURP and OP. However, more high-quality RCTs with larger sample sizes and longer follow-ups need to be carried out to obtain better evidence.

[A meta-analysis of holmium laser enucleation of the prostate for benign prostatic hyperplasia].

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[A meta-analysis of holmium laser enucleation of the prostate for benign prostatic hyperplasia].