Complications of GreenLight Laser vs Transurethral Resection of the Prostate for Treatment of Lower Urinary Tract Symptoms: Meta-analysis of Randomized Trials

OBJECTIVE To compare perioperative outcomes and complications between GreenLight and transurethral resection of the prostate (TURP) for benign prostatic hyperplasia. METHODS A systematic review and random effects meta -analysis of randomized trials comparing GreenLight with TURP was completed. Primary outcomes included periprocedural milestones, 12 predefined complications, Clavien-Dindo class III -V complications, reoperations (all -cause), and a composite of reoperations and readmissions. Metaregression assessed the relationship between patient- and study -level factors with periprocedural outcomes and reoperation rates. RESULTS The review included 13 randomized trials with 1757 patients (839 GreenLight; 918 TURP). Procedure time was 10 minutes (95% CI: 5 to 15; P < .001) longer with GreenLight, while catheterization time (mean difference = -1.3 days; 95% CI: -1.7 to -0.9; P < .001) and hospital stay (mean difference = -2.1 days; 95% CI: -2.5 to -1.7; P < .001) were shorter. Bleeding -related complications, including clot retention (risk ratio [RR] = 0.12; 95% CI: 0.05 to 0.32; P < .001) and transfusion (RR = 0.26; 95% CI: 0.12 to 0.58; P = .001), as well as sexual dysfunction (RR = 0.66; 95% CI: 0.45 to 0.98; P = .04), were less frequent with GreenLight. All other complications occurred at similar frequencies between groups. The risks of reoperation (RR: 1.17; 95% CI: 0.82 to 1.66; P = .38) and reoperation or readmission (RR: 1.05; 95% CI: 0.76 to 1.44; P = .79) did not differ. CONCLUSION GreenLight achieved shorter catheterization times and hospital stays with lower rates of sexual dysfunction and bleeding -related complications compared to TURP. UROLOGY 184: 259- 265, 2024. (c) 2023 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/ 4.0/).