Prostate enucleation, better with low or high-power holmium laser? A systematic review

To assess current efficacyand safety of low power HoLEP (Holmium Laser Enucleationof the Prostate) for the treatment of obstructingand symptomatic prostatic adenomas and to identify themechanisms supporting the related clinical advantages. METHODS: A systematic review was conducted usingrelevant databases (Ovid Medline, PubMed, Scopusand Web of Sciences), employing ("low power" OR"high power") AND ("HoLEP" OR "holmium laser enucleationof the prostate") as search terms. Inherent publicationswere selected according to the Preferred ReportingItems for Systematic Reviews and Meta-analyses (PRISMA)guidelines. Additionally, the reference lists of theselected papers were checked manually. RESULTS: We included any kind of study (n=15) dealingwith low power HoLEP because of the scarcity of the resultsobtained with the bibliographic search. Low powerHoLEP seems to be fully comparable to the traditionalhigh power HoLEP in terms of feasibility, efficacy andsafety. An additional clinical advantage of the low powerapproach might be the reduced incidence of postoperativedysuria, with limited intensity and duration, possiblydue to the decreased amount of energy delivered tothe capsular plane with a less aggressive modality, conjugatedwith appropriate technical enucleative choices.The physical rationale of low power HoLEP is discussed. CONCLUSIONS: Low power HoLEP is feasible, safeand effective, and might play a not exclusive role in thereduction of incidence, intensity and duration of postoperative dysuria.