PROSTATE ENUCLEATION, BETTER WITH LOW OR HIGH-POWER HOLMIUM LASER? A SYSTEMATIC REVIEW

OBJECTIVE: To assess current efficacy and safety of low power HoLEP (Holmium Laser Enucleation of the Prostate) for the treatment of obstructing and symptomatic prostatic adenomas and to identify the mechanisms supporting the related clinical advantages. METHODS: A systematic review was conducted using relevant databases (Ovid Medline, PubMed, Scopus and Web of Sciences), employing ("low power" OR "high power") AND ("HoLEP" OR "holmium laser enucleation of the prostate") as search terms. Inherent publications were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Additionally, the reference lists of the selected papers were checked manually. RESULTS: We included any kind of study (n=15) dealing with low power HoLEP because of the scarcity of the results obtained with the bibliographic search. Low power HoLEP seems to be fully comparable to the traditional high power HoLEP in terms of feasibility, efficacy and safety. An additional clinical advantage of the low power approach might be the reduced incidence of postoperative dysuria, with limited intensity and duration, possibly due to the decreased amount of energy delivered to the capsular plane with a less aggressive modality, conjugated with appropriate technical enucleative choices. The physical rationale of low power HoLEP is discussed. CONCLUSIONS: Low power HoLEP is feasible, safe and effective, and might play a not exclusive role in the reduction of incidence, intensity and duration of postoperative dysuria.