Efficacy of holmium laser enucleation of the prostate in patients with detrusor underactivity: systematic review and meta-analysis

Abstract

Background: Benign prostatic hyperplasia (BPH) is commonly found in the aging male. Treatment of BPH can be in form of conservative or surgical intervention. Transurethral resection of the prostate (TURP) is the gold-standard treatment for BPH according to the guideline. However, there is no evidence that there is a benefit for TURP in patients with detrusor underactivity (DUA). Holmium laser enucleation (HoLEP) is theorized to have a better outcome due to its property of complete prostate enucleation. Therefore, this meta-analysis aims to determine the benefit of HoLEP for BPH patients with DUA. Main body: We performed systematic literature searching from five databases including PubMed, Scopus, Embase, Science Direct, and Web of Science for articles up to 31 December 2020 for relevant studies. A total of five articles are eligible for this meta-analysis. A total of 2.180 subjects participated in all of the studies included. Two studies comparing patients with and without DUA that was treated with HoLEP, two studies comparing HoLEP with other surgical approaches for BPH, and one study comparing both parameters. IPSS score reduction is significantly higher in the patients with DUA (Mean Difference = 3.28, 95% CI 1.91 to 4.64, p < 0.01). Qmax and PVR are not significantly different between both groups. HoLEP also showed better improvement in IPSS and Qmax compared to TURP (IPSS: Mean Difference = -4.80, 95% CI − 7.83 to − 1.77, p = 0.002; Qmax: Mean Difference = 4.20, 95% CI 0.58 to 7.82, p = 0.02) and PVP (IPSS: Mean Difference = − 2.47, 95% CI − 4.47 to − 0.47, p = 0.02; Qmax: Mean Difference = 2.31, 95% CI 0.34 to 4.28, p = 0.02). Conclusion: HoLEP showed better improvement in IPSS scores in patients with DUA. HoLEP can be considered to be performed in the BPH patients with DUA for better outcomes for the patients.