Skip navigation

Laser vs TURP for BPH: systematic review

 

Clinical bottom line

This review pulls together the information, but fails to perform any useful analysis.


Reference

RM Hoffman et al. Laser prostatectomy versus transurethral resection for treating benign prostatic obstruction: a systematic review. Journal of Urology 2003 169: 210-215.

Study

Several electronic databases were searched and several journals hand searched in addition. Studies had to enrol men symptomatic of benign prostatic obstruction, compared laser to TURP, randomly assigned men to treatment groups, had at least 10 subjects per group and followed them up for at least six months. Urinary symptoms and or flow data were the required outcomes.

Results

There were 1,488 men in 16 trials, with 733 assigned to TURP, 374 to noncontact lasers, 244 to contact lasers and 137 to hybrid laser techniques. Mean age was 67 years, symptom score 20, and baseline peak urinary flow rate 9.5 mL/second. Follow up was six to 12 months.

Hospital stay was shorter with lasers than with resection (Figure 1). Mean catheter duration appeared to be longer with laser, and some studies showed a much higher proportions of re operations with laser than with resection. Re operation after resection was uncommon, and was generally zero; with laser operations it could be as high as 10-20%.

Figure 1: Hospital stay


Laser and resections both increased peak urinary flow rate and improved symptoms, at six and 12 months.

Adverse events after resection and different laser operations are shown in Table 1, though for some the amount of information was limited.

Adverse event

Resection %

Noncontact laser%

Contact laser %

Hybrid laser %

Clot retention

7

1

0

4

Dysuria

12

26

9

Epididymitis

1

2

1

7

Erectile dysfunction

5

3

6

Retrograde ejaculation

53

23

32

19

Strictures

8

0

4

7

Transfusions

7

0

0

1

Resection syndrome

1

0

0

Urinary incontinence

1

0

1

1

Urinary retention

5

12

17

5

Urinary tract infections

5

11

4

18

Comment

This is a somewhat frustrating review, because they find all the papers, and give all the information about the outcomes from individual trials, there was a failure to perform any sort of useful analysis. In particular, there are pros and cons to the use of lasers, and some benefits and some harms. This is a topic that could usefully do with another attempt to make something more useful of the data.