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.	刘春晓. 传统经尿道前列腺电切术不应再是前列腺增生腔内治疗的金标准. 现代泌尿外科杂志, 2012, 17(3): 298-299.
4.	陈忠, 叶章群. 激光在良性前列腺增生症手术中的应用. 临床泌尿外科杂志, 2015, 30(9): 767-771.
5.	高建, 曹凤宏, 姜伟, 等. 1470 nm 激光对高龄前列腺增生患者的疗效研究. 中国医药指南, 2017, 15(21): 158-159.
6.	邱晓拂, 张化儒, 杨国胜. 1470 nm 半导体激光治疗良性前列腺增生的研究进展. 现代泌尿生殖肿瘤杂志, 2017, 9(3): 190-192.
7.	章俊, 王曦龙, 史朝亮, 等. 经尿道 1470 nm 半导体激光汽化剜除术与等离子电切术治疗抗凝条件下良性前列腺增生患者疗效的随机对照研究. 中国激光医学杂志, 2018, 27(2): 120.
8.	谷鸿秋, 王杨, 李卫. Cochrane 偏倚风险评估工具在随机对照研究 Meta 分析中的应用. 中国循环杂志, 2014, 29(2): 147-148.
9.	唐雪莉, 高霑, 李幼平, 等. 聚焦超声治疗有症状宫颈柱状上皮异位疗效和安全性的 Meta 分析. 中国循证医学杂志, 2015, 15(4): 425-438.
10.	丁竹. 1470 nm 半导体激光前列腺汽化术与经尿道前列腺电切术治疗良性前列腺增生的临床疗效比较. 石家庄: 河北联合大学, 2015.
11.	许佳佳. 经尿道 1470 nm 半导体激光汽化术治疗前列腺增生症. 唐山: 华北理工大学, 2016.
12.	王成昊, 刘修恒, 翁小东, 等. 经尿道汽化电切术与 1470 nm 半导体激光汽化术治疗前列腺增生的疗效比较. 国际泌尿系统杂志, 2017, 37(6): 862-865.
13.	辛锋, 刘久华, 杨斌, 等. 用 1470 nm 半导体激光前列腺汽化术治疗良性前列腺增生的疗效分析. 当代医药论丛, 2017, 15(20): 4-5.
14.	谭健秋, 程伟文, 吴映红, 等. 1470 nm 激光气化术与经尿道前列腺电切术治疗良性前列腺增生的效果观察. 中国当代医药, 2018, 25(16): 81-83.
15.	陈宁, 曹凤宏, 张立国, 等. 经尿道前列腺电切术与 1470 nm 半导体激光汽化术治疗前列腺增生的疗效比较. 岭南现代临床外科, 2016, 16(1): 92-95.
16.	潘道勇, 刘成, 刘雪军, 等. 1470 nm 半导体激光前列腺汽化术与经尿道前列腺电切术治疗良性前列腺增生的效果比较. 中国综合临床, 2016, 32(5): 451-455.
17.	谭文昌, 何晶晶, 于晓明. 1470 nm 激光气化术和经尿道前列腺电切术治疗良性前列腺增生的效果分析. 河北医科大学学报, 2016, 37(11): 1279-1281.
18.	高江涛, 景治安, 刘彦军, 等. 1470 nm 半导体激光对大体积前列腺患者疗效评价及比较. 黑龙江医学, 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.	刘志峰, 赵永伟, 刘义东, 等. 1470 nm 半导体激光汽化术治疗前列腺增生(附 156 例报告). 微创泌尿外科杂志, 2015, 4(1): 20-22.
23.	王森, 李峻, 李文雄, 等. 1470 nm 激光汽化术治疗良性前列腺增生疗效分析(附 36 例报告). 现代泌尿生殖肿瘤杂志, 2015, 7(4): 216-218.
24.	周发友, 章小毅, 王允武, 等. 经尿道 1470 纳米半导体激光汽化术治疗前列腺增生的疗效分析. 中国内镜杂志, 2016, 22(12): 26-29.
25.	张志涛, 王杰, 武旗. 1470 nm 半导体激光汽化术与经尿道前列腺电切术后的炎症及应激反应程度比较. 海南医学院学报, 2018, 24(3): 349-352.
26.	刘克普, 门群利, 张更, 等. 经尿道钬激光碎石术联合 1470 nm 半导体激光前列腺气化术治疗良性前列腺增生症合并膀胱结石的效果. 临床医学研究与实践, 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. 刘春晓. 传统经尿道前列腺电切术不应再是前列腺增生腔内治疗的金标准. 现代泌尿外科杂志, 2012, 17(3): 298-299.
4. 陈忠, 叶章群. 激光在良性前列腺增生症手术中的应用. 临床泌尿外科杂志, 2015, 30(9): 767-771.
5. 高建, 曹凤宏, 姜伟, 等. 1470 nm 激光对高龄前列腺增生患者的疗效研究. 中国医药指南, 2017, 15(21): 158-159.
6. 邱晓拂, 张化儒, 杨国胜. 1470 nm 半导体激光治疗良性前列腺增生的研究进展. 现代泌尿生殖肿瘤杂志, 2017, 9(3): 190-192.
7. 章俊, 王曦龙, 史朝亮, 等. 经尿道 1470 nm 半导体激光汽化剜除术与等离子电切术治疗抗凝条件下良性前列腺增生患者疗效的随机对照研究. 中国激光医学杂志, 2018, 27(2): 120.
8. 谷鸿秋, 王杨, 李卫. Cochrane 偏倚风险评估工具在随机对照研究 Meta 分析中的应用. 中国循环杂志, 2014, 29(2): 147-148.
9. 唐雪莉, 高霑, 李幼平, 等. 聚焦超声治疗有症状宫颈柱状上皮异位疗效和安全性的 Meta 分析. 中国循证医学杂志, 2015, 15(4): 425-438.
10. 丁竹. 1470 nm 半导体激光前列腺汽化术与经尿道前列腺电切术治疗良性前列腺增生的临床疗效比较. 石家庄: 河北联合大学, 2015.
11. 许佳佳. 经尿道 1470 nm 半导体激光汽化术治疗前列腺增生症. 唐山: 华北理工大学, 2016.
12. 王成昊, 刘修恒, 翁小东, 等. 经尿道汽化电切术与 1470 nm 半导体激光汽化术治疗前列腺增生的疗效比较. 国际泌尿系统杂志, 2017, 37(6): 862-865.
13. 辛锋, 刘久华, 杨斌, 等. 用 1470 nm 半导体激光前列腺汽化术治疗良性前列腺增生的疗效分析. 当代医药论丛, 2017, 15(20): 4-5.
14. 谭健秋, 程伟文, 吴映红, 等. 1470 nm 激光气化术与经尿道前列腺电切术治疗良性前列腺增生的效果观察. 中国当代医药, 2018, 25(16): 81-83.
15. 陈宁, 曹凤宏, 张立国, 等. 经尿道前列腺电切术与 1470 nm 半导体激光汽化术治疗前列腺增生的疗效比较. 岭南现代临床外科, 2016, 16(1): 92-95.
16. 潘道勇, 刘成, 刘雪军, 等. 1470 nm 半导体激光前列腺汽化术与经尿道前列腺电切术治疗良性前列腺增生的效果比较. 中国综合临床, 2016, 32(5): 451-455.
17. 谭文昌, 何晶晶, 于晓明. 1470 nm 激光气化术和经尿道前列腺电切术治疗良性前列腺增生的效果分析. 河北医科大学学报, 2016, 37(11): 1279-1281.
18. 高江涛, 景治安, 刘彦军, 等. 1470 nm 半导体激光对大体积前列腺患者疗效评价及比较. 黑龙江医学, 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. 刘志峰, 赵永伟, 刘义东, 等. 1470 nm 半导体激光汽化术治疗前列腺增生(附 156 例报告). 微创泌尿外科杂志, 2015, 4(1): 20-22.
23. 王森, 李峻, 李文雄, 等. 1470 nm 激光汽化术治疗良性前列腺增生疗效分析(附 36 例报告). 现代泌尿生殖肿瘤杂志, 2015, 7(4): 216-218.
24. 周发友, 章小毅, 王允武, 等. 经尿道 1470 纳米半导体激光汽化术治疗前列腺增生的疗效分析. 中国内镜杂志, 2016, 22(12): 26-29.
25. 张志涛, 王杰, 武旗. 1470 nm 半导体激光汽化术与经尿道前列腺电切术后的炎症及应激反应程度比较. 海南医学院学报, 2018, 24(3): 349-352.
26. 刘克普, 门群利, 张更, 等. 经尿道钬激光碎石术联合 1470 nm 半导体激光前列腺气化术治疗良性前列腺增生症合并膀胱结石的效果. 临床医学研究与实践, 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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