Vineet Gauhar1, Peter Gilling2, Giacomo Maria Pirola3, Vinson Wai-Shun Chan4, Ee Jean Lim5, Martina Maggi6, Jeremy Yuen-Chun Teoh7, Amy Krambeck8, Daniele Castellani9. 1. Department of Urology, Ng Teng Fong General Hospital, Jurong East, Singapore. 2. University of Auckland, Bay of Plenty Clinical Campus, Tauranga, New Zealand. 3. Department of Urology, San Donato Hospital, Arezzo, Italy. 4. School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK. 5. Department of Urology, Singapore General Hospital, Singapore. 6. Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy. 7. S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China. 8. Division of Endourology, Northwestern University, Chicago, IL, USA. 9. Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy. Electronic address: castellanidaniele@gmail.com.
Abstract
CONTEXT: Holmium laser enucleation of the prostate (HoLEP) is currently the size-independent gold standard for surgical treatment of benign prostate enlargement (BPE). OBJECTIVE: To systematically review the current literature and compare perioperative parameters, early outcomes, and complications after HoLEP with MOSES technology LEP (MoLEP) for BPE. EVIDENCE ACQUISITION: This study was performed according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework using the PICOS (Patient, Intervention Comparison, Outcome, Study) model to frame the clinical question. The population was adults undergoing LEP for BPE, with standard HoLEP as the intervention and MoLEP as the comparison. The outcomes were enucleation time, surgical time, haemostasis time, energy used, hospital length of stay (LOS), recatheterisation, urethral stricture rate, and functional outcomes. The study type included randomised, prospective nonrandomised, and retrospective studies. EVIDENCE SYNTHESIS: Seven studies were included for meta-analysis after screening. Mean enucleation time was significantly shorter for MoLEP (mean difference [MD] -7.27 min, 95% confidence interval [CI] -11.26 to -3.28; p = 0.0004). Postoperative LOS was significantly longer in the HoLEP group (MD 0.3 d, 95% CI -0.24-0.85,p<0.0001). Although not statistically significant, there was a trend for higher incidence of recatheterisation (odds ratio [OR] 1.39, 95% CI 0.47-4.09; p = 0.55) and urethral stricture (OR 1.81, 95% CI 0.45-7.37; p = 0.41) in the HoLEP group. The mean maximum peak flow favoured HoLEP (MD 0.95 ml/s, 95% CI -1.66 to 3.57; p = 0.47) and a lower mean postvoid residual volume was noted in the MoLEP group (MD -10.08 ml, 95% CI -53.54 to 33.37; p = 0.65). CONCLUSIONS: MoLEP performed better in terms of intraoperative outcomes compared to standard HoLEP, resulting in shorter enucleation, haemostasis, and total surgical times for similar energy delivered. In addition, postoperative LOS with an early trial of catheter favours MoLEP, making it appealing as a day surgery procedure. PATIENT SUMMARY: We reviewed the literature for early outcomes of laser treatment of the prostate for tissue removal using a MOSES system in comparison to standard treatment with a holmium laser for BPE. We found that the MOSES laser system can improve intraoperative performance, making prostate treatment a same-day discharge surgery.
CONTEXT: Holmium laser enucleation of the prostate (HoLEP) is currently the size-independent gold standard for surgical treatment of benign prostate enlargement (BPE). OBJECTIVE: To systematically review the current literature and compare perioperative parameters, early outcomes, and complications after HoLEP with MOSES technology LEP (MoLEP) for BPE. EVIDENCE ACQUISITION: This study was performed according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework using the PICOS (Patient, Intervention Comparison, Outcome, Study) model to frame the clinical question. The population was adults undergoing LEP for BPE, with standard HoLEP as the intervention and MoLEP as the comparison. The outcomes were enucleation time, surgical time, haemostasis time, energy used, hospital length of stay (LOS), recatheterisation, urethral stricture rate, and functional outcomes. The study type included randomised, prospective nonrandomised, and retrospective studies. EVIDENCE SYNTHESIS: Seven studies were included for meta-analysis after screening. Mean enucleation time was significantly shorter for MoLEP (mean difference [MD] -7.27 min, 95% confidence interval [CI] -11.26 to -3.28; p = 0.0004). Postoperative LOS was significantly longer in the HoLEP group (MD 0.3 d, 95% CI -0.24-0.85,p<0.0001). Although not statistically significant, there was a trend for higher incidence of recatheterisation (odds ratio [OR] 1.39, 95% CI 0.47-4.09; p = 0.55) and urethral stricture (OR 1.81, 95% CI 0.45-7.37; p = 0.41) in the HoLEP group. The mean maximum peak flow favoured HoLEP (MD 0.95 ml/s, 95% CI -1.66 to 3.57; p = 0.47) and a lower mean postvoid residual volume was noted in the MoLEP group (MD -10.08 ml, 95% CI -53.54 to 33.37; p = 0.65). CONCLUSIONS: MoLEP performed better in terms of intraoperative outcomes compared to standard HoLEP, resulting in shorter enucleation, haemostasis, and total surgical times for similar energy delivered. In addition, postoperative LOS with an early trial of catheter favours MoLEP, making it appealing as a day surgery procedure. PATIENT SUMMARY: We reviewed the literature for early outcomes of laser treatment of the prostate for tissue removal using a MOSES system in comparison to standard treatment with a holmium laser for BPE. We found that the MOSES laser system can improve intraoperative performance, making prostate treatment a same-day discharge surgery.
Authors: Giacomo Maria Pirola; Daniele Castellani; Martina Maggi; Ee Jean Lim; Vinson Wai Shun Chan; Angelo Naselli; Jeremy Yuen Chun Teoh; Vineet Gauhar Journal: Cent European J Urol Date: 2022-06-22