Comparative efficacy and safety of low-power versus high-power holmium laser enucleation of the prostate for benign prostatic hyperplasia: an updated meta-analysis
Abstract
Background: Holmium laser enucleation of the prostate (HoLEP) is the gold-standard surgical treatment for benign prostatic hyperplasia, irrespective of the prostate size. However, the optimal laser power setting remains uncertain. High-power systems (80–100 W) are commonly used in clinical practice, while emerging evidence suggests that low-power settings (24–50 W) may offer comparable efficacy with potential functional and safety advantages. Objective: To compare the perioperative, functional, and safety outcomes of low-power versus high-power HoLEP based on randomized controlled trials. Methods: We conducted a systematic review and meta-analysis of RCT comparing low-power (24–50 W) and high-power (80–100 W) HoLEP, searching four electronic databases from inception till April 2025. The data extracted on primary outcomes include International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), post-void residual volume (PVR), quality of life (QoL), and Clavien–Dindo-graded complications. Secondary outcomes included operative efficiency metrics. A random-effects model was used to calculate pooled effect sizes with 95% confidence intervals. Risk of bias was assessed using the Cochrane risk of bios (RoB 2) tool. Results: Four trials (n = 394) were included. Low-power and high-power HoLEP showed similar IPSS improvement [MD: −0.30 (95% CI: −1.00 to 0.41)] and Qmax (0.30 ml/s, −0.42 to 1.01). Low-power HoLEP resulted in better QoL [MD: 0.20 (95% CI: 0.10–0.31] and…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 394 participants or records.
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