Holmium laser enucleation versus bipolar enucleation of the prostate in Benign prostatic obstruction: a meta-analysis of randomized controlled trials

Fulin Zhang¹Jinbin Xu²Qin Zhu #³Jinyue Zheng #⁴Ciming Sun³Fuyang Dai³Zhu Wang¹Hui Liang^1*

• ¹Shenzhen Longhua People's Hospital, Shenzhen, China
• ²Department of Urology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
• ³First Clinical Medical College, Guangdong Medical University, Zhanjiang, Guangdong Province, China
• ⁴Department of Pathology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China

Objective The objective of this research was to assess both the effectiveness and safety of holmium laser enucleation of the prostate (HoLEP) and bipolar enucleation of the prostate (BipoLEP) in the treatment of benign prostatic hyperplasia (BPH). Method We conducted a meta-analysis (PROSPERO Registration: CRD42020201780) that had a comprehensive search in PubMed, Embase, Cochrane Library, and WanFang databases until August 1st, 2024 for available randomized controlled trials (RCTs). The inclusion criteria were: (1) RCTs comparing HoLEP vs BipoLEP for BPH, (2) Reporting outcome: Qmax, IPSS, QoL, PVR, PSA and omplications, (3) Adult patients (≥18 years) with Qmax<15ml/s. Result Ultimately, our meta-analysis encompassed a comprehensive total of 14 randomized controlled trials (RCTs), involving 1,466 participants. The outcomes evaluated, including maximal flow rate (Qmax), international prostate symptom score (IPSS), quality of life (QoL), post-void residual (PVR), prostate-specific antigen (PSA) levels, blood transfusion rates, incontinence, and urethral stenosis post-surgery, demonstrated no statistically significant differences between HoLEP and BipoLEP procedures (P>0.05). However, several perioperative metrics revealed significant disadvantages for BipoLEP compared to HoLEP. Specifically, BipoLEP was associated with a longer operative time (MD: 14.86, P=0.04), extended hospitalization duration (SMD: 0.87, P<0.001), prolonged catheterization time (SMD: 1.05, P=0.001), increased bladder irrigation time (SMD: 2.05, P=0.005), and a higher overall complication rate (RR: 1.83, P=0.02). Subgroup analyses further elucidated that BipoLEP resulted in a significantly longer operative time (MD: 27.21,P<0.002) compared to HoLEP in the large prostate volume group (≥80 ml). Conversely, in the small prostate volume group (<80 ml), BipoLEP exhibited a lower overall complication rate (RR: 1.82, P=0.03). Conclusions In conclusion, our findings revealed that HoLEP and BipoLEP procedures exhibited comparable outcomes in terms of Qmax, IPSS, QoL, PVR, postoperative blood transfusion rates, incontinence, and urethral stenosis. Nevertheless, HoLEP demonstrated superior perioperative outcomes and a lower overall complication rate compared to BipoLEP. Specifically, HoLEP was associated with a shorter operative time in the large prostate volume group and a reduced overall complication rate in the small prostate volume group.