Comparison of perioperative and functional outcomes of holmium laser enucleation of prostate with different power: A systematic review and meta-analysis

Objective: The objective is to systematically review the perioperative and prognostic outcome differences between low-power (LP) and high-power (HP) holmium laser enucleation of the Prostate (HoLEP). Methods: Up to 2023, we systematically searched English databases such as PubMed, EMBASE, Google Scholar, SinoMed, CNKI for related original research literature. Review Manager 5.4 software was used for meta-analysis. Pooled odds ratios (ORs), weight mean differences (WMDs) and standard mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using the fixed-effects or random-effects model. Publication bias was evaluated using funnel plots. Results: We identified 1026 records in the literature search. After screening titles, abstracts, and full texts, we finally selected and included 5 studies. This meta-analysis (5 trials) showed that in intraoperative variables, HP HoLEP is superior to LP HoLEP in terms of enucleation efficiency, but there was no significant difference in operative time; there was no significant difference in postoperative outcomes (length of hospital stay, postoperative catheterization time), postoperative incontinence rates, and related complications between the two groups. There was no significant difference in postoperative functional outcomes (IPSS; Qmax; QOL; PVR). Conclusion: Compared to LP HoLEP, HP HoLEP has a certain advantage in terms of enucleation efficiency; there is no significant difference in other aspects; however, LP HoLEP consumes less energy and is more energy-efficient and environmentally friendly. Furthermore, further comparative research is still needed to elevate the level of evidence. Registration: The study protocol was registered with PROSPERO(CRD42023445989).