{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T16:31:26Z","timestamp":1790181086561,"version":"4.1.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Robot-assisted simple prostatectomy (RASP) and laser enucleation of the prostate (LEP) are established surgical options for the treatment of large-volume benign prostatic hyperplasia (BPH); however, consensus regarding the superiority of one technique over the other has not been established. This study aimed to comprehensively compare the perioperative efficiency, safety, and functional outcomes of RASP and LEP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a comprehensive search of four databases (PubMed, Embase, Web of Science, and Scopus) to identify studies comparing RASP and LEP in large-volume BPH. Pooled and subgroup analyses were performed using Stata MP 18 and Review Manager 5.4.0.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifteen studies (2,231 patients, 763 RASP and 1,468 LEP) were included in the analysis. LEP was associated with shorter operative time and catheterization duration than RASP. Hospital stay was reduced with thulium fiber laser enucleation of the prostate (ThuLEP; mean difference [MD] 2.43, 95% confidence interval [CI] 1.52\u20133.34,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), but not with holmium fiber laser enucleation of the prostate (HoLEP). Specimen weights were comparable overall (MD 3.61, 95% CI \u221211.29\u201318.51,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.60), although ThuLEP yielded smaller specimens (MD 28.44, 95% CI 12.17\u201344.71,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.01). Low- and high-grade Clavien\u2013Dindo complications were comparable between groups, while RASP was associated with incidence of lower urinary incontinence (OR 0.48, 95% CI 0.27\u20130.85,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.01) and superior improvements in International Prostate Symptom Score (MD \u22121.33, 95% CI \u22122.41\u2013\u22120.26,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.015) and post-void residual (MD \u22123.95, 95% CI \u22127.28\u2013\u22120.61,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.020), with International Prostate Symptom Score benefit observed primarily at long-term follow-up (\u226512\u202fmonths, MD \u22121.45, 95% CI \u22122.24\u2013\u22120.67,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.012). Maximum urinary flow rate and quality of life were comparable across groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Both RASP and LEP may be safe and effective surgical options for large-volume BPH. LEP may be associated with faster perioperative recovery, whereas RASP may reduce the incidence of UI and potentially improve long-term symptom control. Given the observational design of included studies, heterogeneity across cohorts, and limitations of retrospective evidence, these findings should be interpreted with caution, and tailored surgical strategies are recommended.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1804731","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T05:32:40Z","timestamp":1777959160000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Robot-assisted simple prostatectomy vs. laser enucleation of the prostate for large-volume benign prostatic hyperplasia (BPH, \u226580\u202fmL): a systematic review and meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Xiaoming","family":"Hao","sequence":"first","affiliation":[{"name":"Department of Urology, Heping Hospital Affiliated to Changzhi Medical College","place":["Changzhi, Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sicheng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Urology, Heping Hospital Affiliated to Changzhi Medical College","place":["Changzhi, Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Urology, Heping Hospital Affiliated to Changzhi Medical College","place":["Changzhi, Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tongyi","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Urology, Heping Hospital Affiliated to Changzhi Medical College","place":["Changzhi, Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Urology, Heping Hospital Affiliated to Changzhi Medical College","place":["Changzhi, Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,5]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1097\/JU.0000000000003698","article-title":"Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH): AUA guideline amendment 2023","volume":"211","author":"Sandhu","year":"2024","journal-title":"J Urol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1007\/s11934-021-01081-7","article-title":"Office-based procedures for BPH","volume":"22","author":"Gao","year":"2021","journal-title":"Curr Urol Rep"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"674","DOI":"10.23736\/S2724-6051.24.05940-8","article-title":"Comparative analysis of the long-term efficacy and safety of minimally invasive simple prostatectomy and endoscopic enucleation of the prostate for large benign prostatic hyperplasia (>80 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hyperplasia","volume":"8","author":"Li","year":"2021","journal-title":"Front Med (Lausanne)"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"914","DOI":"10.1016\/j.euf.2024.06.005","article-title":"Thulium fiber versus holmium:yttrium-aluminum-garnet laser for endoscopic enucleation of the prostate: a systematic review and meta-analysis","volume":"10","author":"Uleri","year":"2024","journal-title":"Eur Urol Focus"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"2633","DOI":"10.1007\/s11701-023-01715-7","article-title":"Efficacy and safety of transurethral thulium laser enucleation versus robot-assisted prostatectomy for large-volume benign prostatic hyperplasia: a systematic review and meta-analysis","volume":"17","author":"Wen","year":"2023","journal-title":"J Robot Surg"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1007\/s11701-025-02577-x","article-title":"Comparative outcomes of holmium laser enucleation of the prostate (HoLEP) 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robot-assisted simple prostatectomy","volume":"31","author":"Zhang","year":"2017","journal-title":"J Endourol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1016\/j.ajur.2025.03.016","article-title":"A comparison between thulium fiber laser enucleation of the prostate and robot-assisted simple prostatectomy in the surgical management of large benign prostatic hyperplasia","volume":"12","author":"Audige","year":"2025","journal-title":"Asian J Urol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1007\/s00345-025-06113-2","article-title":"Functional outcomes and safety profile of thulium: YAG laser enucleation (ThuLEP) versus robot-assisted simple prostatectomy (RASP) facing very large (\u2265\u202f150 ml) prostates","volume":"44","author":"Perri","year":"2025","journal-title":"World J Urol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"678","DOI":"10.1159\/000530627","article-title":"Perioperative outcome of thulium 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Health"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1097\/JU.0000000000004297","article-title":"Comparative analysis of holmium laser enucleation of the prostate and robotic-assisted simple prostatectomy in benign prostatic hyperplasia management: a systematic review and meta-analysis","volume":"213","author":"Benzouak","year":"2025","journal-title":"J Urol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1038\/s41391-023-00743-6","article-title":"Comparison of perioperative and short-terms outcomes of en-bloc holmium laser enucleation of the prostate (HoLEP) and robot-assisted simple prostatectomy: a propensity-score matching analysis","volume":"27","author":"Grosso","year":"2024","journal-title":"Prostate Cancer Prostatic Dis"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1007\/s00345-024-05097-9","article-title":"The long-term learning curve of holmium laser enucleation of the prostate (HoLEP) in the en-bloc technique: a single surgeon series of 500 consecutive cases","volume":"42","author":"Wenk","year":"2024","journal-title":"World J Urol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"2037","DOI":"10.1097\/JS9.0000000000000345","article-title":"The learning curves of major laparoscopic and robotic procedures in urology: a systematic review","volume":"109","author":"Chahal","year":"2023","journal-title":"Int J Surg"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1016\/j.aju.2015.10.001","article-title":"Holmium laser enucleation versus simple prostatectomy for treating large prostates: results of a systematic review and meta-analysis","volume":"14","author":"Jones","year":"2016","journal-title":"Arab J Urol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1007\/s11934-017-0746-z","article-title":"Holmium laser enucleation of the prostate: patient selection and outcomes","volume":"18","author":"Kuebker","year":"2017","journal-title":"Curr Urol Rep"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1804731\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T05:32:41Z","timestamp":1777959161000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1804731\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,5]]},"references-count":34,"alternative-id":["10.3389\/fmed.2026.1804731"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1804731","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,5]]},"article-number":"1804731"}}