Five trials (435 patients, range 20 to 120) were included in the review. All trials addressed incomplete data and were free of selective reporting. Four trials had adequate sequence generation. Two trials had blinding. One trial had adequate allocation concealment.
Functional results: There was no evidence of a significant difference between groups for International Prostate Symptom Score or maximum flow rate at six, 12 and 24 months follow-up. Significant heterogeneity in findings was identified at six months follow-up; sensitivity analysis suggested that the heterogeneity was associated with prostate volume.
Complications: Compared with resection, laser vaporisation was associated with a reduced risk of capsule perforation (RR 0.08, 95% CI 0.01 to 0.63; Ι²=0%; two RCTs), transurethral resection syndrome (RR 0.17, 95% CI 0.03 to 0.94; Ι²=0%; three RCTs), blood transfusion (RR 0.09, 95% CI 0.02 to 0.39; Ι²=0%; four RCTs) and clot retention (RR 0.13, 95% CI 0.04 to 0.38; Ι²=0%; two RCTs) but an increased risk of reoperation (RR 3.64, 95% CI 1.07 to 12.35; Ι²=0%; two RCTs). There was no evidence of a significant difference in the risk of other complications (acute urinary retention or urethral or bladder neck stenosis) between groups.
Other outcomes: Compared with resection, laser vaporisation was associated with a longer operation time (MD 14.53 minutes, 95% CI 0.38 to 28.69; Ι²=93%; four RCTs) but a shorter duration of catheterisation (MD -40.12 minutes, 95% CI -51.62 to -28.62; Ι²=80%; four RCTs) and shorter duration of hospital stay (MD -2.24 days, 95% CI -2.78 to -1.71; Ι²=84%; three RCTs). Sensitivity analysis suggested that the 120 watt laser reduced the difference in operation time when compared with resection to seven minutes; this difference was still significantly different. Sensitivity analysis suggested that larger prostate volume may have influenced the higher rate of reoperation with laser treatment.