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Lasers in Transurethral Enucleation of the Prostatea??Do We Really Need Them

DOI:10.3390/jcm9051412 期刊:Journal of Clinical Medicine 出版年份:2020 更新时间:2025-09-23 15:21:01
摘要: The acronym EEP, coding for transurethral Endoscopic Enucleation of the Prostate, was introduced in 2016 by the European Association of Urology (EAU) guidelines panel on management of non-neurogenic male lower urinary tract symptoms (LUTS) and benign prostatic obstruction (BPO). Since then, a laser-based treatment, Holmium Laser Enucleation of the Prostate (HoLEP), and the current-based treatment of bipolar enucleation of the prostate (BipoLEP) are equally appreciated as valuable options for the management of benign prostatic obstruction (BPO). This was mainly inspired by the results of two meta-analyses on randomized controlled trials, comparing open prostatectomy with either Holmium Laser Enucleation of the Prostate (HoLEP) or bipolar enucleation of the prostate (BipoLEP). Prior to that, HoLEP was embraced as the only valid option for transurethral enucleation, although evidence for equivalence existed as early as 2006, but was not recognized due to a plethora of acronyms for bipolar energy-based treatments and practiced HoLEP-centrism. On the other hand, the academic discourse focused on different (other) laser approaches that came up, led by Thulium:Yttrium-Aluminum-Garnet (Tm:YAG) Vapoenucleation (ThuVEP) in 2009 and, finally, transurethral anatomical enucleation with Tm:YAG support (thulium laser enucleation of the prostate, ThuLEP) in 2010. Initially, the discourse on lasers focused on the different properties of lasers rather than technique or surgical anatomy, respectively. In and after 2016, the discussion ultimately moved towards surgical technique and accepting anatomical preparation as the common of all EEP techniques (AEEP). Since then, the unspoken question has been raised, whether lasers are still necessary to perform EEP in light of existing evidence, given the total cost of ownership (TCO) for these generators. This article weighs the current evidence and comes to the conclusion that no evidence of superiority of one modality over another exists with regard to any endpoint. Therefore, in the sense of critical importance, AEEP can be safely and effectively performed without laser technologies and without compromise.
作者: Thomas R.W. Herrmann,Stavros Gravas,Jean JMCH de la Rosette,Mathias Wolters,Aristotelis G. Anastasiadis,Ioannis Giannakis
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To evaluate the necessity of lasers in transurethral enucleation of the prostate (EEP) for the treatment of benign prostatic obstruction (BPO) by comparing laser-based and current-based techniques.

The study concludes that no evidence of superiority of one modality over another exists with regard to any endpoint in the treatment of benign prostatic obstruction. Anatomical enucleation of the prostate (AEEP) can be safely and effectively performed without laser technologies, without compromising postoperative outcomes.

The study is limited by the scarcity of high-quality randomized controlled trials with low risk of bias, imprecision, inconsistency, indirectness, and publication bias. The comparison of different energy sources is challenging due to the heterogeneity of techniques and the lack of standardized outcomes.

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