Comparing General Anaesthesia With Spinal Anaesthesia for Holmium Laser Enucleation of Prostate: A Systematic Review and Meta-Analysis

Holmium laser enucleation of the prostate (HoLEP) is an established surgical treatment for benign prostatic hyperplasia (BPH). Although it is conventionally performed under general anaesthesia (GA), spinal anaesthesia (SA) may represent an important alternative for patients with significant medical comorbidity. We performed a systematic review and meta-analysis comparing peri-operative outcomes of HoLEP performed under GA versus SA. A systematic review and meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of electronic databases was performed (MEDLINE, PubMed, EMBASE and Google Scholar) for comparative studies evaluating GA versus SA for HoLEP. A random-effects meta-analysis was performed using mean difference (MD) or odds ratio (OR) with 95% confidence intervals (CI). A search of electronic databases found four studies, enrolling a total of 2323 patients. SA was associated with a significantly shorter operative time than GA (P=0.03), although this finding was not robust on leave-one-out sensitivity analysis. There were no significant differences in resected tissue weight (P=0.73), Hb drop (P=0.07), post-operative catheter reinsertion (P=0.34), Clavien-Dindo grade ≥3 complications (P=0.14), change in IPSS (P=0.91), change in QMax (P=0.60), or change in PVR (P=1.00). Moderate to high heterogeneity was observed for several outcomes, and the available evidence was limited to retrospective and propensity-matched studies. Current evidence suggests that spinal anaesthesia could be a safe and effective alternative to general anaesthesia for HoLEP, with comparable intra- and post-operative outcomes. SA may expand access to HoLEP for patients at increased risk from GA. However, the available evidence remains limited, and high-quality prospective randomised studies are required to confirm these findings.