Bipolar Transurethral Versus Holmium Laser Enucleation of the Prostate for Benign Prostatic Hyperplasia: An Updated Meta-Analysis

Bipolar transurethral enucleation of the prostate (B-TUEP) and holmium laser enucleation of the prostate (HoLEP) were part of the European guidelines for endoscopic treatment of benign prostatic hyperplasia (BPH), a previous meta-analysis compared the two surgical approaches, but the literature has been updated recently. We performed this meta-analysis by searching PubMed, Web of Science, and EMBASE databases for eligible studies. Perioperative characteristics, complications, and functional outcomes were compared. Subgroup analysis was also performed according to prostate volume (PV). RevMan version 5.3 was used for the analysis. A total of 14 studies involving 2317 BPH patients were included in this study; the catheterization time of HoLEP was significantly shorter than that of B-TUEP (p = 0.002), and urinary retention of HoLEP was significantly lesser than that of B-TUEP (p = 0.04). HoLEP had advantages on hemoglobin drop (p = 0.007), overall complication (p = 0.04), urinary retention (p = 0.04), and long-term IPSS (p = 0.0006) for PV less than 80 ml. The catheterization time was shorter (p = 0.002), and long-term IIEF was better (p = 0.02) in the HoLEP group than B-TUEP group for PV more than 80 ml. HoLEP has more advantages than B-TUEP. For small prostate, it is mainly manifested as less bleeding and fewer complications, while reducing catheterization time and better protecting sexual function for large prostates.