PURPOSE As the prevalence of benign prostatic hyperplasia (BPH) increases, the demand for surgical interventions that optimize patient outcomes while minimizing complications grows. This systematic review compares the efficacy, efficiency, and safety of holmium laser enucleation of the prostate (HoLEP) with robotic-assisted simple prostatectomy (RASP), providing insights for evidence-based surgical decision-making in BPH treatment. MATERIALS AND METHODS Adhering to PRISMA guidelines, the study protocol was registered with Prospero [CRD42024509627]. Searches were conducted in Medline, Embase, Web of Science, Scopus, and CINAHL up to February 1, 2024, to include studies that compare HoLEP and RASP in patients with BPH. Risk of bias was evaluated using the Newcastle Ottawa Scale. RESULTS HoLEP and RASP demonstrated equivalent effectiveness in treating BPH, as shown by similar functional outcomes such as maximum urinary flow rate and postvoid residual volume. However, HoLEP outperformed RASP in several operational efficiency metrics, reducing operative time by 49.48 minutes, hospitalization duration by 1.5 days, and catheterization period by 3.8 days. HoLEP also significantly reduced the risk of blood transfusions by 75%. Patients undergoing RASP were 1.87 times more at risk for grade 2 complications and 3.41 times more at risk for developing grade 3 or above complications. CONCLUSIONS HoLEP and RASP are effective for managing BPH. HoLEP shows advantages in recovery metrics and lower blood transfusion rates, while RASP benefits from ease of implementation in robotic-equipped facilities. Optimizing surgical outcomes will depend on reducing disparities in technique adoption, improving surgical training, and aligning with evidence-based guidelines.

中文翻译：

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BPH 管理中钬激光前列腺摘除术 （HoLEP） 和机器人辅助简单前列腺切除术 （RASP） 的比较分析：系统评价和荟萃分析。


目的 随着良性前列腺增生 （BPH） 患病率的增加，对优化患者预后同时最大限度地减少并发症的手术干预的需求也在增长。本系统评价比较了钬激光前列腺摘除术 （HoLEP） 与机器人辅助简单前列腺切除术 （RASP） 的疗效、效率和安全性，为 BPH 治疗的循证手术决策提供见解。材料和方法 根据 PRISMA 指南，研究方案在 Prospero [CRD42024509627] 注册。在 Medline 、 Embase、 Web of Science 、 Scopus 和 CINAHL 中进行了检索，检索时间截至 2024 年 2 月 1 日，纳入了比较 BPH 患者 HoLEP 和 RASP 的研究。使用 Newcastle Ottawa 量表评估偏倚风险。结果 HoLEP 和 RASP 在治疗 BPH 方面显示出相当的有效性，如相似的功能结果（如最大尿流率和排尿后残余尿量）所示。然而，HoLEP 在几个运营效率指标上优于 RASP，手术时间缩短了 49.48 分钟，住院时间缩短了 1.5 天，导管插入期缩短了 3.8 天。HoLEP 还显着降低了 75% 的输血风险。接受 RASP 的患者发生 2 级并发症的风险高 1.87 倍，发生 3 级或以上并发症的风险高 3.41 倍。结论 HoLEP 和 RASP 对 BPH 的治疗有效。HoLEP 在恢复指标和较低的输血率方面显示出优势，而 RASP 则受益于在配备机器人的设施中易于实施。优化手术结果将取决于减少技术采用的差异、改善手术培训以及与循证指南保持一致。