ObjectiveTo evaluate the safety and clinical efficacy of transurethral holmium laser enucleation of the prostate (HoLEP) versus transurethral plasma kinetic enucleation of the prostate (PKEP) in the treatment of benign prostate hyperplasia (BPH).MethodsRandomized controlled trials of HoLEP versus PKEP in the treatment of BPH published between January 2000 and March 2021 were searched in PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Chongqing VIP database, and Wanfang database. Operative duration, estimated intraoperative blood loss, average duration of urinary catheterization, average duration of bladder irrigation, average length of hospital stay, and postoperative complications were used as safety evaluation indicators. Postoperative International Prostatic Symptomatic Score (IPSS), postoperative maximum urinary flow rate (Qmax), postoperative quality of life (QoL), and postvoid residual (PVR) were used as effective evaluation indicators.ResultsA total of 14 randomized controlled trials were included in this study, with a total of 1 478 patients (744 in the HoLEP group and 734 in the PKEP group). The results of the meta-analysis showed that the intraoperative blood loss in the HoLEP group was less than that in the PKEP group [weighted mean difference (WMD)=−25.95 mL, 95% confidence interval (CI) (−31.65, 20.25) mL, P=0.025], the average duration of urinary catheterization [WMD=−10.35 h, 95%CI (−18.25, −2.45) h, P=0.042], average duration of bladder irrigation [WMD=−10.28 h, 95%CI (−17.52, −3.04) h, P=0.038], and average length of hospital stay [WMD=−1.24 d, 95%CI (−1.85, −0.62) d, P=0.033] in the HoLEP group were shorter than those in the PKEP group, and the incidence of postoperative complications [risk ratio=0.70, 95%CI (0.56, 0.87), P=0.047] and 6-month postoperative Qmax [WMD=−0.89 m/s, 95%CI (−1.74, −0.05) m/s, P=0.037] in the HoLEP group were lower than those in the PKEP group. However, there was no significant difference in the operative duration, 3-month postoperative IPSS, 3-month postoperative Qmax, 3-month postoperative QoL, 3-month postoperative PVR, 6-month postoperative IPSS, 6-month postoperative QoL, or 6-month postoperative PVR between the two groups (P>0.05).ConclusionsIn the treatment of BPH, the effectiveness of HoLEP does not differ from that of PKEP, but HoLEP is safer. The conclusions of this study need to be verified in more precisely designed and larger sample-sized multi-center randomized controlled trials.
Objective To access the efficacy and safety of Holmium laser prostatectomy technique compared to TURP. Methods We searched MEDLINE (1996 to 2004), EMBASE (1984 to 2004), The Cochrane Library (Issue 4, 2004), CNKI, VIP, CMCC and CBMdisc; and handsearched the relevant Chinese journals. Randomized controlled trials (RCT) were included. The quality of trials was evaluated and meta-analysis was performed. Non-randomized controlled trials were also included to evaluate the safety and efficacy. Results We found 4 randomized controlled trials. A total of 480 participants were in the trials ranging from 60 to 200. There was no statistical difference between the two techniques at 12 or 48 months follow-up in terms of quality of life (QOL) improvement（WMD=-0.19, 95%CI -0.81 to 0.44, Z=0.59, P=0.56; WMD=-0.30, 95%CI -0.90 to 0.30, Z=0.98, P=0.33); Qmax improvement（WMD=1.63 ml/s, 95%CI -0.32 to 3.59, Z=1.64, P=0.10; WMD=3.80 ml/s, 95%CI -1.36 to 8.96,Z=1.44, P=0.15); I-PSS or AUA (WMD=-0.06, 95%CI -1.01 to 0.89, Z=0.12, P=0.91; WMD=-1.40, 95%CI -3.91 to 1.11, Z=1.09, P=0.27) and the urethral stricture complication rate (RR=0.75, 95%CI 0.35 to 1.60, Z=0.74, P=0.46). However hospital stay was significantly shorter in the Holmium laser prostatectomy groups (total WMD=-24.89, 95%CI -28.56 to -21.21, Z=13.27, P＜0.000 01). We can not draw consistent conclusions in terms of blood loss according to the present data. One study indicated Holmium laser prostatectomy technique was more cost-effective than TURP. Conclusions In short period Holmium laser prostatectomy is as safe as TURP in terms of hospital stay, urethral stricture and blood loss complication. This new technique is as effiective as TURP in terms of I-PSS (AUA), Qmax and QOL. More RCTs and more long term follow-up is necessary.
ObjectiveTo summarize experience of endoscopic reverse biliary tract stent placement via choledochus in treatment of situs inversus totalis complicated with choledocholithiasis.MethodThe clinical data of one patient with situs inversus totalis complicated with choledocholithiasis in the Department of Tumor Surgery of Lanzhou University Second Hospital were retrospectively analyzed.ResultsThe ERCP was failed at the first admission, followed by the cholecystectomy plus choledocholithotomy plus T-tube drainage, the stones were removed. Two months later, choledochoscopy revealed multiple choledocholithiasis, then the holmium laser lithotripsy and bile duct stent placement was performed at the secondary admission, the postoperative recovery was good, it had been more than 2 months after the surgery, no stone recurrence occurred.ConclusionEndoscopic reverse biliary tract stent placement via choledochus is feasible, which can be used as an option for treatment of patient with situs inversus totalis complicated with choledocholithiasis.
ObjectivesTo systematically evaluate the efficacy and safety of the transurethral bipolar plasmakinetic prostatectomy (TUPKP) versus holmium laser enucleation of the prostate (HoLEP) for treatment of benign prostatic hyperplasia (BPH).MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of TUPKP and HoLEP for treatment of BPH from inception to January 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, the meta-analyses were performed by using RevMan 5.3 software.ResultsA total of 9 RCTs involving 784 patients were included. The results of meta-analyses showed that, in efficacy outcomes, TUPKP was superior to HoLEP in Qmax at 48 months, and was inferior to HoLEP in PVR at 3 months, Qmax in 60 and 72 months, and IIEF-5 at 48 and 72 months. No significant association was found between two groups in Qmax from 1 to 36 months, IPSS from 1 to 72 months, prostate volume, PVR from 6 months, IIEF-5 from 1 to 24 months, QoL at 1 to 36 months, and resected prostate weight. As for safety, TUPKP was superior to HoLEP in operation time, while inferior to HoLEP in blood loss during procedure, hospital stay, catheterization period, bladder irrigation period, irrigation fluid, massive hemorrhage and hematuresis. No significant association was observed between two groups in serum sodium decrease, hemoglobin decrease, PSA, postoperative urine retention, blood transfusion, cystospasm, temporary incontinence, urinary tract infection, TURS, epididymitis, temporary difficulty in urination, urinary tract irritation syndrome, reoperation, retrograde ejaculation, urinary incontinence, ED and urethrostenosis.ConclusionsCurrent evidence shows that the efficacy and safety of TUPKP and HoLEP for treatment of BPH are similar. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo investigate the clinical efficacy and safety of lithotripsy under flexible ureteroscope using 200 μm holmium laser for medullary sponge kidney stones. MethodsWe identified and retrospectively reviewed 10 patients who underwent flexible ureteroscopic lithotripsy for medullary sponge kidney calculi between January 2013 and July 2014. The remission of clinical symptoms and incidence of perioperative complications were observed. ResultsThe staged surgery was performed on 10 bilateral cases with one session for each kidney. The operative time of our cohort was 130-180 minutes. The postoperative average hemoglobin was not significantly reduced (110.6 g/L) as compared with preoperative average hemoglobin (116.8 g/L) (P>0.05). Two patients had fever after operation and temperatures became normal by anti-infection. The renal function and plain film of kidney-ureter-bladokr (KUB) and CT scan were rechecked for all cases on three months after operation. The kidney function in 3 cases of chronic renal failure was ameliorated to varying degrees. The postoperative average of serum creatinine (196.2 μmol/L) was reduced as compared with the preoperative average serum creatinine (385.7 μmol/L) (P<0.05). Six patients reported spontaneous discharge of residuary stones during three months after surgery. KUB and CT scan proved significant reduction of the loads of stones for all cases after operation. ConclusionFlexible ureteroscope with 200 μm holmium laser lithotripsy is a safe and effective treatment for medullary sponge kidney stones based on its effect on amelioration of symptom and renal function.
ObjectiveTo compare the clinical efficacy of transurethral plasmakinetic resection of bladder tumors (PKRBT) and holmium laser resection of bladder tumors (HOLBT), and discuss the effcacy, safety, indication, and complications of PKRBT for the treatment of bladder tumors compared with HOLBT. MethodsA hundred patients with bladder tumors were divided into two groups randomly, who were selected from patients in the Department of Urology of West China Hospital from March 2011 to March 2013. Among all the 100 cases, half of them were treated with PKRBT, and all others treated with HOBLT. The significant markers in both groups were recorded and evaluated, including the situation of before operation, during operation and after operation. The data recorded consisted of the general records of patients' medical background, concomitant disease, laboratory examination, and the position, amount, pathology of the tumor, total operative duration, the time of gross hematuria, the time of postoperative bladder irrigation and catheterization, the length of stay, postoperative complications and patients' conditions at month 3, 6, and 12 during the follow-up. ResultsAll operations were successfully performed, and there was no significant diTherences between the two groups in preoperative indexes (P>0.05). No abnormalities were detected in the postoperative laboratory examinations. The diTherences in operatative duration, time of bladder irrigation, duration of indwelling catheter, and postoperative length of stay between the two groups were not significant (P>0.05). But the mean time of gross hematuria was significantly shorter after operation in the HOLBT patients [(6.1±7.6) hours] than in those treated with PKRBT [(15.3±17.2) hours] (P<0.05). There was no significant diTherence between the two groups in the recurrence rate 3, 6, and 12 months after operation (P>0.05). ConclusionHOLBT can be used safely and effectively in treating bladder tumors, and it is easy for clinical manipulation. HOLBT is as effective and safe as PKRBT with similar adverse side-effect rate within and after operation.