Holmium Laser Prostatectomy Vs. Turp

A technology assessment report 1 on the use of holmium laser in the treatment of benign prostatic hyperplasia (BPH) was abstracted in the Health Technology Assessment Database 2. Studies that compare the use of holmium laser resection of the prostate (HoLRP) and holmium laser enucleation of the prostate (HoLEP) with transurethral resection of the prostate (TURP) are limited in number. Three randomised controlled trials comparing HoLRP and TURP and two comparing HoLEP and TURP were identified in the systematic review. Only one of the five RCTs were considered to be of good quality. There was also one uncontrolled comparative study comparing each of the holmium techniques with TURP. The remainder of the evidence was in the form of case series.

The holmium laser procedures appear to be equivalent to TURP for symptom relief. TURP was found to be superior to the holmium laser procedures in terms of operative times and retrieved more tissue than HoLRP. The addition of the mechanical morcellator in the HoLEP technique appeared to result in more tissue being retreived than in TURP. Both the holmium laser techniques and TURP were found to retrieve adequate tissue for postoperative histology to detect undiagnosed prostate cancer. The lack of long-term follow-up in the majority of holmium laser studies meant that no conclusion could be drawn about the long-term durability of the procedures in comparison to TURP. Cost-effectiveness was addressed in one RCT comparing HoLRP and TURP, which suggested that HoLRP may be more cost-effective than TURP. However, longer term follow-up and studies in other settings would be required to determine whether this finding can be generalised.

In terms of the primary safety issue from a clinical perspective blood loss both of the holmium laser procedures (HoLRP and HoLEP) were found to be superior to TURP. There did not appear to be a difference between the holmium laser procedures and TURP for rates of stricture or urinary tract infection.

Comment: The quality of evidence is downgraded by study quality (inadequate follow up).

References

• Tooher R L. A systematic review of holmium laser prostatectomy. Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S). 2003. 147. Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S). (www.surgeons.org/asernip-s/).
• Health Technology Assessment Database: HTA-20030532. The Cochrane Library, Issue 1, 2004. Chichester, UK: John Wiley & Sons, Ltd.