Clinical Report: Low- vs High-Power Lasers in HoLEP for BPH

Overview

This systematic review and meta-analysis compared low-power (20–50 W) and high-power (80–100 W) holmium laser enucleation of the prostate (HoLEP) in benign prostatic hyperplasia (BPH) treatment. The analysis focused on postoperative functional recovery, enucleation efficiency, hemoglobin decrease, and complication rates, integrating data primarily from randomized controlled trials (RCTs).

Background

Benign prostatic hyperplasia (BPH) with lower urinary tract symptoms significantly impacts aging men’s quality of life. Transurethral resection of the prostate (TURP) has been the traditional surgical standard but carries risks such as bleeding and TURP syndrome. HoLEP has emerged as a minimally invasive alternative, effective for prostates of varying sizes and potentially becoming the new gold standard. High-power lasers offer rapid tissue enucleation but at higher costs, whereas low-power lasers are more cost-effective and versatile but require further evaluation for efficacy and safety.

Data Highlights

The meta-analysis included prospective comparative studies and RCTs comparing low-power and high-power HoLEP. Primary outcomes assessed were International Prostate Symptom Score (IPSS) at 3 months post-surgery and intraoperative enucleation efficiency (EE). Secondary outcomes included maximum urinary flow rate (Qmax), post-void residual urine volume (PVR), quality of life (QoL) scores at 3 and 6 months, hemoglobin decrease, and complication rates.

Key Findings

• Low-power HoLEP demonstrated comparable postoperative functional recovery to high-power HoLEP, including similar IPSS improvements at 3 months.
• Enucleation efficiency was not significantly different between low-power and high-power laser settings, indicating effective tissue removal with both.
• Hemoglobin decrease and intraoperative bleeding rates were similar, suggesting comparable safety profiles.
• Complication rates did not significantly differ, supporting the safety of low-power HoLEP.
• Low-power HoLEP offers cost advantages and greater versatility without compromising clinical outcomes.

Clinical Implications

Clinicians may consider low-power HoLEP as an effective and safe alternative to high-power systems, especially in settings where cost or equipment availability is a concern. The comparable functional outcomes and complication profiles support its broader adoption for BPH surgical management. This approach may expand access to minimally invasive prostate surgery without sacrificing efficacy.

Conclusion

Low-power HoLEP provides similar efficacy and safety to high-power HoLEP in treating BPH, with added benefits of cost-effectiveness and versatility. These findings support the integration of low-power laser systems into clinical practice for prostate enucleation.

References

1. 1 -- Impact of BPH on Quality of Life
2. 2 -- Limitations of TURP
3. 3 -- HoLEP as New Gold Standard
4. 4 -- Advantages of HoLEP for Large Prostates
5. 5 -- Use of High-Power Lasers in HoLEP
6. 6 -- Cost Barriers of High-Power Laser Systems
7. 7 -- Comparisons of Low-Power and High-Power HoLEP
8. 8,9 -- Limitations of Previous Meta-Analyses
9. 10 -- PRISMA Guidelines