Comparative efficacy and safety of greenlight and thulium laser vaporization techniques for benign prostatic hyperplasia: a systematic review and meta-analysis.

ABSTRACT

This meta-analysis evaluates the efficacy and safety of greenlight (PVP) and thulium laser vaporization (ThuVAP) in Benign Prostatic Hyperplasia (BPH) treatment. A systematic literature search was conducted in databases including PubMed, Cochrane Library, EMBASE, CNKI, Wangfang, and VIP in November 2023. Following the PRISMA guidelines, a systematic review and meta-analysis of the primary outcomes of interest were performed. The review was prospectively registered on PROSPERO under the registration number CRD42023491316. A total of 13 studies were included. The results of the meta-analysis showed that compared to PVP, ThuVAP had a shorter operation time (MD 8.56, 95% CI 4.10 ~ 13.03, p = 0.0002), and higher postoperative transfusion (OR0.26, 95% CI 0.10 ~ 0.64, p = 0.004). However, no significant differences were observed between the two groups in terms of length of stay (MD -0.32, 95% CI -0.78 ~ 0.14, p = 0.17), catherization time (MD 0.03, 95% CI -0.13 ~ 0.19, p = 0.73), international prostate symptom score improvement (MD 0.23, 95% CI -0.36 ~ 0.81, p = 0.45), quality of life improvement (MD 0.04, 95% CI -0.04 ~ 0.12, p = 0.29), maximum urinary flow rate improvement (MD -0.59, 95% CI -1.42 ~ 0.24, p = 0.16), postvoid residual urine volume improvement (MD 1.04, 95% CI -6.63 ~ 8.71, p = 0.79), overall postoperative complications (OR1.15, 95% CI 0.65 ~ 2.03, p = 0.63), postoperative bleeding (OR1.18, 95%  CI 0.67 ~ 2.07, p = 0.56), re-peration (OR0.55, 95% CI 0.16 ~ 1.95, p = 0.35), urethral stricture (OR0.90, 95% CI 0.46 ~ 1.75, p = 0.75), and urinary incontinence (OR1.07, 95% CI 0.64 ~ 1.78, p = 0.80). The results of subgroup analysis showed that the results of comparing thulium vaporesection or vapoenucleation with PVP were consistent with the results of the pooled analysis. Both greenlight and thulium laser vaporization are effective and safe, with comparable surgical and functional outcomes. The choice between these methods should be based on patient-specific factors.