Efficacy and safety of 1 470 nm laser vaporization <i>vs</i>. transurethral resection of prostate for benign prostatic hyperplasia: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

CHE Peng ^1,2 ,  WEI Xin ¹ , ZENG Xiongfeng ¹ , GAO Xiaoshuai ¹ , WANG Kunjie ¹ , LI Hong ¹

1. Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
2. The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, 621000, P.R.China;

Corresponding?author：

WEI Xin, Email: wxmd01@gmail.com

Keywords：

Transurethral resection of prostate; 1 470 nm laser vaporization; Benign prostatic hyperplasia; Meta-analysis; Systematic review; Randomized controlled trial; Non-randomized controlled trial

DOI：

10.7507/1672-2531.201810105

Video：

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Objectives To systematically evaluate the efficacy and safety of 1 470 nm laser vaporization vs. transurethral resection of prostate (TURP) for benign prostatic hyperplasia (BPH).Methods PubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) and non-randomized controlled trials (non-RCTs) about the efficacy and safety of 1 470 nm laser vaporization vs. TURP for BPH from inception to October 22^nd, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.Results A total of 6 RCTs and 4 non-RCTs were included. The results of meta-analysis showed that: 1 470 nm laser vaporization was superior to TURP in reducing intraoperative bleeding (MD=?103.87, 95%CI ?148.08 to ?59.65, P<0.000 01), hospital stay (MD=?3.82, 95%CI ?4.35 to ?3.28, P<0.000 01), postoperative indwelling catheter time (MD=?2.24, 95%CI ?3.45 to ?1.02, P=0.000 3), postoperative hemoglobin (MD=?1.63, 95%CI ?3.14 to ?0.12, P=0.03) and rate of secondary hemorrhage (OR=0.13, 95%CI 0.03 to 0.48, P=0.002). There were no significant differences in operative time, bladder irrigation time, transient urinary incontinence and urethral stricture, IPSS Score and Q_max at 3 months after operation between the two groups (P>0.05).Conclusion Current evidence shows that 1 470 nm laser vaporization is superior to TURP in reducing intraoperative bleeding and secondary hemorrhage. It may be more suitable for prostate surgery in anticoagulant or coagulative dysfunction patients. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

Citation： CHE Peng, WEI Xin, ZENG Xiongfeng, GAO Xiaoshuai, WANG Kunjie, LI Hong. Efficacy and safety of 1 470 nm laser vaporization vs. transurethral resection of prostate for benign prostatic hyperplasia: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2019, 19(5): 565-570. doi: 10.7507/1672-2531.201810105 Copy

1.	Madersbacher S, Alivizatos G, Nordling J, et al. EAU 2004 guidelines on assessment, therapy and follow-up of men with lower urinary tract symptoms suggestive of benign prostatic obstruction (BPH guidelines). Eur Urol, 2004, 46(5): 547-554.
2.	Unnikrishnan R, Almassi N, Fareed K. Benign prostatic hyperplasia: Evaluation and medical management in primary care. Cleve Clin J Med, 2017, 84(1): 53-64.
3.	劉春曉. 傳統經尿道前列腺電切術不應再是前列腺增生腔內治療的金標準. 現代泌尿外科雜志, 2012, 17(3): 298-299.
4.	陳忠, 葉章群. 激光在良性前列腺增生癥手術中的應用. 臨床泌尿外科雜志, 2015, 30(9): 767-771.
5.	高建, 曹鳳宏, 姜偉, 等. 1470 nm 激光對高齡前列腺增生患者的療效研究. 中國醫藥指南, 2017, 15(21): 158-159.
6.	邱曉拂, 張化儒, 楊國勝. 1470 nm 半導體激光治療良性前列腺增生的研究進展. 現代泌尿生殖腫瘤雜志, 2017, 9(3): 190-192.
7.	章俊, 王曦龍, 史朝亮, 等. 經尿道 1470 nm 半導體激光汽化剜除術與等離子電切術治療抗凝條件下良性前列腺增生患者療效的隨機對照研究. 中國激光醫學雜志, 2018, 27(2): 120.
8.	谷鴻秋, 王楊, 李衛. Cochrane 偏倚風險評估工具在隨機對照研究 Meta 分析中的應用. 中國循環雜志, 2014, 29(2): 147-148.
9.	唐雪莉, 高霑, 李幼平, 等. 聚焦超聲治療有癥狀宮頸柱狀上皮異位療效和安全性的 Meta 分析. 中國循證醫學雜志, 2015, 15(4): 425-438.
10.	丁竹. 1470 nm 半導體激光前列腺汽化術與經尿道前列腺電切術治療良性前列腺增生的臨床療效比較. 石家莊: 河北聯合大學, 2015.
11.	許佳佳. 經尿道 1470 nm 半導體激光汽化術治療前列腺增生癥. 唐山: 華北理工大學, 2016.
12.	王成昊, 劉修恒, 翁小東, 等. 經尿道汽化電切術與 1470 nm 半導體激光汽化術治療前列腺增生的療效比較. 國際泌尿系統雜志, 2017, 37(6): 862-865.
13.	辛鋒, 劉久華, 楊斌, 等. 用 1470 nm 半導體激光前列腺汽化術治療良性前列腺增生的療效分析. 當代醫藥論叢, 2017, 15(20): 4-5.
14.	譚健秋, 程偉文, 吳映紅, 等. 1470 nm 激光氣化術與經尿道前列腺電切術治療良性前列腺增生的效果觀察. 中國當代醫藥, 2018, 25(16): 81-83.
15.	陳寧, 曹鳳宏, 張立國, 等. 經尿道前列腺電切術與 1470 nm 半導體激光汽化術治療前列腺增生的療效比較. 嶺南現代臨床外科, 2016, 16(1): 92-95.
16.	潘道勇, 劉成, 劉雪軍, 等. 1470 nm 半導體激光前列腺汽化術與經尿道前列腺電切術治療良性前列腺增生的效果比較. 中國綜合臨床, 2016, 32(5): 451-455.
17.	譚文昌, 何晶晶, 于曉明. 1470 nm 激光氣化術和經尿道前列腺電切術治療良性前列腺增生的效果分析. 河北醫科大學學報, 2016, 37(11): 1279-1281.
18.	高江濤, 景治安, 劉彥軍, 等. 1470 nm 半導體激光對大體積前列腺患者療效評價及比較. 黑龍江醫學, 2017, 41(7): 625-627.
19.	Seitz M, Sroka R, Gratzke C, et al. The diode laser: a novel side-firing approach for laser vaporisation of the human prostate-immediate efficacy and 1-year follow-up. Eur Urol, 2007, 52(6): 1717-1722.
20.	Zhao Y, Liu C, Zhou G, et al. A retrospective evaluation of benign prostatic hyperplasia treatment by transurethral vaporization using a 1470 nm laser. Photomed Laser Surg, 2013, 31(12): 626-629.
21.	Liu Z, Zhao Y, Wang X, et al. Critical reviews of 1470 nm laser vaporization on benign prostatic hyperplasia. Lasers Med Sci, 2018, 33(2): 323-327.
22.	劉志峰, 趙永偉, 劉義東, 等. 1470 nm 半導體激光汽化術治療前列腺增生(附 156 例報告). 微創泌尿外科雜志, 2015, 4(1): 20-22.
23.	王森, 李峻, 李文雄, 等. 1470 nm 激光汽化術治療良性前列腺增生療效分析(附 36 例報告). 現代泌尿生殖腫瘤雜志, 2015, 7(4): 216-218.
24.	周發友, 章小毅, 王允武, 等. 經尿道 1470 納米半導體激光汽化術治療前列腺增生的療效分析. 中國內鏡雜志, 2016, 22(12): 26-29.
25.	張志濤, 王杰, 武旗. 1470 nm 半導體激光汽化術與經尿道前列腺電切術后的炎癥及應激反應程度比較. 海南醫學院學報, 2018, 24(3): 349-352.
26.	劉克普, 門群利, 張更, 等. 經尿道鈥激光碎石術聯合 1470 nm 半導體激光前列腺氣化術治療良性前列腺增生癥合并膀胱結石的效果. 臨床醫學研究與實踐, 2019, 4(1): 6-8.

1. Madersbacher S, Alivizatos G, Nordling J, et al. EAU 2004 guidelines on assessment, therapy and follow-up of men with lower urinary tract symptoms suggestive of benign prostatic obstruction (BPH guidelines). Eur Urol, 2004, 46(5): 547-554.
2. Unnikrishnan R, Almassi N, Fareed K. Benign prostatic hyperplasia: Evaluation and medical management in primary care. Cleve Clin J Med, 2017, 84(1): 53-64.
3. 劉春曉. 傳統經尿道前列腺電切術不應再是前列腺增生腔內治療的金標準. 現代泌尿外科雜志, 2012, 17(3): 298-299.
4. 陳忠, 葉章群. 激光在良性前列腺增生癥手術中的應用. 臨床泌尿外科雜志, 2015, 30(9): 767-771.
5. 高建, 曹鳳宏, 姜偉, 等. 1470 nm 激光對高齡前列腺增生患者的療效研究. 中國醫藥指南, 2017, 15(21): 158-159.
6. 邱曉拂, 張化儒, 楊國勝. 1470 nm 半導體激光治療良性前列腺增生的研究進展. 現代泌尿生殖腫瘤雜志, 2017, 9(3): 190-192.
7. 章俊, 王曦龍, 史朝亮, 等. 經尿道 1470 nm 半導體激光汽化剜除術與等離子電切術治療抗凝條件下良性前列腺增生患者療效的隨機對照研究. 中國激光醫學雜志, 2018, 27(2): 120.
8. 谷鴻秋, 王楊, 李衛. Cochrane 偏倚風險評估工具在隨機對照研究 Meta 分析中的應用. 中國循環雜志, 2014, 29(2): 147-148.
9. 唐雪莉, 高霑, 李幼平, 等. 聚焦超聲治療有癥狀宮頸柱狀上皮異位療效和安全性的 Meta 分析. 中國循證醫學雜志, 2015, 15(4): 425-438.
10. 丁竹. 1470 nm 半導體激光前列腺汽化術與經尿道前列腺電切術治療良性前列腺增生的臨床療效比較. 石家莊: 河北聯合大學, 2015.
11. 許佳佳. 經尿道 1470 nm 半導體激光汽化術治療前列腺增生癥. 唐山: 華北理工大學, 2016.
12. 王成昊, 劉修恒, 翁小東, 等. 經尿道汽化電切術與 1470 nm 半導體激光汽化術治療前列腺增生的療效比較. 國際泌尿系統雜志, 2017, 37(6): 862-865.
13. 辛鋒, 劉久華, 楊斌, 等. 用 1470 nm 半導體激光前列腺汽化術治療良性前列腺增生的療效分析. 當代醫藥論叢, 2017, 15(20): 4-5.
14. 譚健秋, 程偉文, 吳映紅, 等. 1470 nm 激光氣化術與經尿道前列腺電切術治療良性前列腺增生的效果觀察. 中國當代醫藥, 2018, 25(16): 81-83.
15. 陳寧, 曹鳳宏, 張立國, 等. 經尿道前列腺電切術與 1470 nm 半導體激光汽化術治療前列腺增生的療效比較. 嶺南現代臨床外科, 2016, 16(1): 92-95.
16. 潘道勇, 劉成, 劉雪軍, 等. 1470 nm 半導體激光前列腺汽化術與經尿道前列腺電切術治療良性前列腺增生的效果比較. 中國綜合臨床, 2016, 32(5): 451-455.
17. 譚文昌, 何晶晶, 于曉明. 1470 nm 激光氣化術和經尿道前列腺電切術治療良性前列腺增生的效果分析. 河北醫科大學學報, 2016, 37(11): 1279-1281.
18. 高江濤, 景治安, 劉彥軍, 等. 1470 nm 半導體激光對大體積前列腺患者療效評價及比較. 黑龍江醫學, 2017, 41(7): 625-627.
19. Seitz M, Sroka R, Gratzke C, et al. The diode laser: a novel side-firing approach for laser vaporisation of the human prostate-immediate efficacy and 1-year follow-up. Eur Urol, 2007, 52(6): 1717-1722.
20. Zhao Y, Liu C, Zhou G, et al. A retrospective evaluation of benign prostatic hyperplasia treatment by transurethral vaporization using a 1470 nm laser. Photomed Laser Surg, 2013, 31(12): 626-629.
21. Liu Z, Zhao Y, Wang X, et al. Critical reviews of 1470 nm laser vaporization on benign prostatic hyperplasia. Lasers Med Sci, 2018, 33(2): 323-327.
22. 劉志峰, 趙永偉, 劉義東, 等. 1470 nm 半導體激光汽化術治療前列腺增生(附 156 例報告). 微創泌尿外科雜志, 2015, 4(1): 20-22.
23. 王森, 李峻, 李文雄, 等. 1470 nm 激光汽化術治療良性前列腺增生療效分析(附 36 例報告). 現代泌尿生殖腫瘤雜志, 2015, 7(4): 216-218.
24. 周發友, 章小毅, 王允武, 等. 經尿道 1470 納米半導體激光汽化術治療前列腺增生的療效分析. 中國內鏡雜志, 2016, 22(12): 26-29.
25. 張志濤, 王杰, 武旗. 1470 nm 半導體激光汽化術與經尿道前列腺電切術后的炎癥及應激反應程度比較. 海南醫學院學報, 2018, 24(3): 349-352.
26. 劉克普, 門群利, 張更, 等. 經尿道鈥激光碎石術聯合 1470 nm 半導體激光前列腺氣化術治療良性前列腺增生癥合并膀胱結石的效果. 臨床醫學研究與實踐, 2019, 4(1): 6-8.

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Chinese Journal of Evidence-Based Medicine

Efficacy and safety of 1 470 nm laser vaporization vs. transurethral resection of prostate for benign prostatic hyperplasia: a meta-analysis

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