| Objective:To compare the holmium laser enucleation(or resection) of the prostate (HoLEP∕ HoLRP) and transurethral resection of the Prostate (TURP),To access the efficacy and safety of Holmium laser prostatectomy.Methods:We searched Pubmed, The Cochrane Library, CNKI,CVIP ;and hand searched the relevant Chinese urology surgery journals from 1993 to 2009.Randomized controlled trials(RCTs) 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. The primary measures were maximum flow rate (Qmax),postvoid residual urine (PVR),international prostate symptom score(I-PSS) and AUA symptom score(AUA-SS) and quality of life(QOL) score. the secondary measures were operation time ,hospital stay, catheter time and the urethral stricture complication rate.Results:We found 5 randomized controlled trials. A total of 580 participants were in the trials ranging from 60 to 200.There was statistical difference between the two techniques in Resection time{Total WMD=19.17,95﹪CI(11.33,27.00), Z=4.79, P<0.00001},Hospital stay{Total WMD=-24.89,95﹪CI(-26.62, -15.98),Z=13.27, P<0.00001 },Catheter time{Total WMD=-18.21,95﹪CI(-26.66,-9.77), Z=4.23,P <0.00001},Postvoid residual urine(PVR) in the follow-up six month {Total WMD=-14.71, 95﹪CI(-20.76,-8.66), Z=4.77,P<0.00001}.The HoLEP∕HoLRP is more longer in Resection time ,and shorter in Hospital stay and Catheter time ,and lower in Postvoid residual urine .But there was no satistical difference between two techniques at 12 or 36 and 48 months follow-up in terms Quality of life(QOL) score {Total WMD=-0.19,95﹪CI(-0.81,0.44),Z=0.59,P=0.56; Total WMD =-0.30,95﹪CI(-0.90,0.30), Z=0.98,P=0.33},Maximum flow rate(Qmax) {Total WMD=2.76, 95﹪CI(0.50,5.01),Z=2.40,P=0.02; Total WMD=1.50,95﹪CI(-1.91,4.91),Z=0.86,P=0.39; Total WMD=3.80,95﹪CI(-1.36,8.96), z=1.44, p=0.15}, I-PSS /AUA-SS{Total WMD=-0.74,95﹪CI(-1.66,0.18), Z=1.57,P=0.12;Total WMD=-0.60,95﹪CI(-1.61,0.41), Z=1.16,P=0.25;Total WMD=-1.40,95﹪CI(-3.91, 1.11), Z=1.09,P=0.27}and Urethral stricture complication rate in the follow-up twelve month {RR=0.72, 95﹪CI(0.35,1.48),Z=0.90,P=0.37}.So there have no difference markedness in Maximum flow rate and the urethral stricture complication rate.Coclusions:In short period HoLEP(and HoLRP) and TURP have similar effect in QOL( rasing Qmax and I-PSS∕AUA-SS) and have no satistical different, Although the resection time of HoLEP (and HoLRP) was longer than that of TURP, the catheter time and hospital stay is shorter. The PVR at six months follow-up of TURP was larger than HoLEP (and HoLRP). Both of them have no difference in the risk of urethral stricture complication .To treat Benign prostatic hyperplasia by holmium laser as efficacy and safety as TURP. But we need more randomized controlled trials and more follow-up time to study.
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