A Cochrane review included 20 studies with a total of 1,898 subjects. Among the studies comparing laser prostatectomy with TURP, the pooled percentage improvements for mean urinary symptoms ranged from 59% to 68% with lasers and 63% to 77% with TURP (mean age 67.2 yrs, mean baseline symptom score 20.2, mean baseline peak urinary flow 9.2 ml/s, follow-up from 6 to 36 months). The improvements for mean peak urinary flow ranged from 56% to 119% with lasers and 96% to 127% with TURP. Overall, laser subjects were less likely to receive transfusions or develop strictures and their hospitalizations were shorter. Non-contact laser subjects were more likely to have dysuria, urinary tract infection, and retention. Re-operation occurred more often following laser procedures. Small sample sizes and differences in study design limit any definitive conclusions regarding the preferred type of laser technique. Data were insufficient to compare laser techniques with other minimally invasive procedures.
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment and blinding).