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Updated: May 12, 2026
Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate HoLEP.
Published on: March 6, 2018
The safety and efficacy of five surgical treatments in prostate enucleation: a network meta-analysis
Yun-Yi Chen1, Wen-Xi Hua2, Yu-Hua Huang1
1Department of Urinary Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China.
Purpose:
The aim of our study was to investigate the comparative outcomes of five different energy types on surgical efficacy and postoperative recovery in patients with benign prostate hyperplasia.
Methods:
The literature was systematically reviewed on December 1st, 2023, encompassing studies retrieved from PubMed, Embase, Web of Science, and The Cochrane Library databases that incorporated clinical studies of holmium laser enucleation of the prostate (HoLEP), Thulium:YAG laser enucleation of the prostate (ThuLEP), transurethral plasmakinetic enucleation of prostate (PKEP), diode laser enucleation of the prostate (DiLEP) and thulium fiber laser enucleation of the prostate (ThuFLEP) in the treatment of prostatic hyperplasia. Two independent reviewers extracted study data and conducted quality assessments using the Cochrane Collaboration's Risk of Bias tool and Newcastle-Ottawa Scale (NOS). Network meta-analysis (NMA) was employed to indirectly analyze the outcomes of endoscopic enucleation of the prostate (EEP) techniques.
Results:
The study included a total of 38 studies, comprising 21 non-randomized controlled trials (nRCTs) and 17 randomized controlled trials (RCTs), incorporating five distinct techniques: holmium laser, Thulium:YAG laser, bipolar plasma, diode laser and thulium fiber laser. In comparing treatment durations, ThuLEP and HoLEP had shorter overall hospital stays than PKEP, while the enucleation time of ThuLEP and HoLEP was shorter than that of ThuFLEP. Moreover, the enucleation tissue weight of both thulium fiber laser and holmium laser was heavier than bipolar plasma. However, the analysis did not reveal any statistically significant variation in complications among the various types of enucleation. In postoperative follow-up, the IPSS at 3 months post-operation was superior in the Thulium:YAG laser group compared to the holmium laser group. The thulium fiber laser technique demonstrated significant advantages over other enucleation methods in terms of QoL and PVR at 12 months after surgery.
Conclusion:
Theoretical properties may vary among different energy sources; however, there are no discernible clinical differences in operation-related parameters, postoperative complications, and postoperative follow-up. Therefore, the choice of laser does not significantly impact the outcome. However, due to the limited number of included studies, future research should focus on larger sample sizes and multicenter investigations to further validate the findings of this study.
Insights
This study compared five energy types for benign prostate hyperplasia surgery. Results showed no significant differences in complications, but Thulium:YAG and Thulium Fiber Laser offered better long-term outcomes.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Medical Technology Assessment
Background:
- Benign prostate hyperplasia (BPH) affects a significant portion of the aging male population.
- Various energy sources are utilized for endoscopic enucleation of the prostate (EEP) to treat BPH.
- Comparative efficacy and recovery data for these energy sources are crucial for clinical decision-making.
Purpose of the Study:
- To systematically review and compare the surgical efficacy and postoperative recovery of five distinct energy types used in BPH treatment.
- To evaluate holmium laser enucleation of the prostate (HoLEP), Thulium:YAG laser enucleation of the prostate (ThuLEP), plasmakinetic enucleation of prostate (PKEP), diode laser enucleation of the prostate (DiLEP), and thulium fiber laser enucleation of the prostate (ThuFLEP).
Main Methods:
- A systematic literature review was conducted across major databases (PubMed, Embase, Web of Science, Cochrane Library) up to December 1st, 2023.
- Included clinical studies assessed HoLEP, ThuLEP, PKEP, DiLEP, and ThuFLEP for BPH treatment.
- Network meta-analysis (NMA) was used to indirectly compare outcomes, with study quality assessed using Cochrane Risk of Bias and Newcastle-Ottawa Scale.
Main Results:
- Thirty-eight studies (17 RCTs, 21 nRCTs) were analyzed, comparing five energy sources.
- ThuLEP and HoLEP demonstrated shorter hospital stays and enucleation times compared to PKEP and ThuFLEP, respectively.
- Thulium Fiber Laser and Holmium Laser yielded greater tissue weight than bipolar plasma; Thulium:YAG showed superior IPSS at 3 months, while Thulium Fiber Laser excelled in QoL and PVR at 12 months, with no significant complication differences across techniques.
Conclusions:
- Despite theoretical differences, no significant clinical variations in operative parameters or complications were observed among the evaluated energy sources for BPH treatment.
- The choice of laser energy source does not appear to significantly impact surgical outcomes.
- Future research with larger sample sizes and multicenter designs is recommended to further validate these findings.
