title: Holmium laser enucleation versus transurethral resection in patients with benign prostate hyperplasia: an updated systematic review with meta-analysis and trial sequential analysis.
abstract: BACKGROUND
  Holmium laser enucleation (HoLEP) in surgical treatment of benign prostate hyperplasia (BPH) potentially offers advantages over transurethral resection of the prostate (TURP).
  
  
  METHODS
  Published randomized controlled trials (RCTs) were identified from PubMed, EMBASE, Science Citation Index, and the Cochrane Library up to October 10, 2013 (updated on February 5, 2014). After methodological quality assessment and data extraction, meta-analysis was performed using STATA 12.0 and Trial Sequential Analysis (TSA) 0.9 software.
  
  
  RESULTS
  Fifteen studies including 8 RCTs involving 855 patients met the criteria. The results of meta-analysis showed that: a) efficacy indicators: there was no significant difference in quality of life between the two groups (P>0.05), but compared with the TURP group, Qmax was better at 3 months and 12 months, PVR was less at 6, 12 months, and IPSS was lower at 12 months in the HoLEP, b) safety indicators: compared with the TURP, HoLEP had less blood transfusion (RR 0.17, 95% CI 0.06 to 0.47), but there was no significant difference in early and late postoperative complications (P>0.05), and c) perioperative indicators: HoLEP was associated with longer operation time (WMD 14.19 min, 95% CI 6.30 to 22.08 min), shorter catheterization time (WMD -19.97 h, 95% CI -24.24 to -15.70 h) and hospital stay (WMD -25.25 h, 95% CI -29.81 to -20.68 h).
  
  
  CONCLUSIONS
  In conventional meta-analyses, there is no clinically relevant difference in early and late postoperative complications between the two techniques, but HoLEP is preferable due to advantage in the curative effect, less blood transfusion rate, shorter catheterization duration time and hospital stay. However, trial sequential analysis does not allow us to draw any solid conclusion in overall clinical benefit comparison between the two approaches. Further large, well-designed, multicentre/international RCTs with long-term data and the comparison between the two approaches remain open.
authors.affiliation: Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan, People's Republic of China.
authors.forename: Sheng
authors.initials: S
authors.lastname: Li
authors.affiliation: Center for Evidence-based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, People's Republic of China.
authors.forename: Xian-Tao
authors.initials: XT
authors.lastname: Zeng
authors.affiliation: Department and Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
authors.forename: Xiao-Lan
authors.initials: XL
authors.lastname: Ruan
authors.affiliation: Center for Evidence-based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, People's Republic of China.
authors.forename: Hong
authors.initials: H
authors.lastname: Weng
authors.affiliation: Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan, People's Republic of China.
authors.forename: Tong-Zu
authors.initials: TZ
authors.lastname: Liu
authors.affiliation: Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan, People's Republic of China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Wang
authors.affiliation: Center for Evidence-based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, People's Republic of China.
authors.forename: Chao
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan, People's Republic of China.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Meng
authors.affiliation: Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan, People's Republic of China.
authors.forename: Xing-Huan
authors.initials: XH
authors.lastname: Wang
mesh_terms: D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications; D011470:Prostatic Hyperplasia / Q000601:surgery*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D020728:Transurethral Resection of Prostate / Q000009:adverse effects; D016896:Treatment Outcome; D014546:Urinary Catheterization