MP20-07 Comparative efficacy and safety of Aquablation versus Holmium Laser Enucleation of Prostate for surgical treatment of Benign Prostatic Hyperplasia: A network meta-analysis

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I (MP20)1 May 2024MP20-07 Comparative efficacy and safety of Aquablation versus Holmium Laser Enucleation of Prostate for surgical treatment of Benign Prostatic Hyperplasia: A network meta-analysis Renil S. Titus, Ansh Bhatia, Rajvi Goradia, Joao G. Porto, Diana M. Lopategui, Robert Marcovich, and Hemendra N. Shah Renil S. TitusRenil S. Titus , Ansh BhatiaAnsh Bhatia , Rajvi GoradiaRajvi Goradia , Joao G. PortoJoao G. Porto , Diana M. LopateguiDiana M. Lopategui , Robert MarcovichRobert Marcovich , and Hemendra N. ShahHemendra N. Shah View All Author Informationhttps://doi.org/10.1097/01.JU.0001008732.80104.31.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Holmium Laser Enucleation of the Prostate (HoLEP) and Aquablation are recognized procedures for surgical treatment of medium and large size benign prostatic hyperplasia (BPH), but a direct comparison is lacking. We conducted a network meta-analysis to assess their safety and efficacy, aiding urologists in shared decision-making. METHODS: We systematically reviewed MEDLINE, Cochrane, and EMBASE databases for RCTs comparing aquablation vs. transurethral resection of the prostate (TURP) and HoLEP vs. TURP, as well as single-arm prospective studies for aquablation and HoLEP until August 31, 2023. The study was registered in PROSPERO. We assessed included studies for bias using the RoB2 tool. Outcomes evaluated include symptoms score (IPSS), peak urinary flow rate (Qmax), postvoid residual urine (PVR), quality of life index (QoL), erectile function (IIEF-5), perioperative outcomes, serious adverse event (SAE) and retreatment rates (RT). RESULTS: We included 22 studies involving 2210 patients. At 1 year HoLEP had a higher improvement in IPSS by 3.81 points (95% CI: 1.73 to 5.84), QoL by 0.16 points (95% CI: -0.41 to 0.73) and Qmax by 4.04 ml/s (95% CI: 1.07 to 6.67). HoLEP had a higher decline in PVR by 57.4 mL (95% CI: 42.9 to 71.9) and higher decline in IIEF-5 scores by 0.75 points (95% CI: -2.43 to 3.43). At 2 years HOLEP had a higher improvement in IPSS by 4.19 points, a higher decline in PVR by 66.5 mL and lower improvement of Qmax by 0.34 mL/s. These differences were not statistically significant (NSS). At 5 years, the differences in IPSS, Qmax or QoL was NSS . HOLEP had a higher total operative times by 27.4 minutes (95% CI: 18.39 to 36.65), shorter post-operative catheterisation time by 15.54 hours (95% CI: -23.46 to -7.73) and shorter hospital stay by 12.5 hours (95% CI: -22.59 to -2.2). HoLEP carries a higher risk of SAE (risk ratio (RR): 1.71, 95% CI: 0.66 to 4.28), lower risk of urinary tract infections (RR: 0.67, 95% CI: 0.06 to 5.18), higher risk of urinary incontinence (RR: 2.62, 95% CI: 0.43 to 20.44), higher risk of urethral strictures (RR: 1.42, 95% CI: 0.35 to 5.68) and lower surgical RT vs aquablation (RR: 0.54, 95% CI: 0.03 to 7.46) at 1 to 3 years. These differences were NSS. CONCLUSIONS: Aquablation results in lower improvement in voiding parameters than HoLEP. It also has less sexual function decline than HoLEP, although NSS. It is associated with shorter operative times, longer postoperative catheterization and hospital stays and favorable SAE rate compared to HoLEP. HoLEP has lower surgical RT than aquablation. Source of Funding: NA © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e322 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Renil S. Titus More articles by this author Ansh Bhatia More articles by this author Rajvi Goradia More articles by this author Joao G. Porto More articles by this author Diana M. Lopategui More articles by this author Robert Marcovich More articles by this author Hemendra N. Shah More articles by this author Expand All Advertisement PDF downloadLoading ...