Efficacy and safety of 1470-nm diode laser enucleation of the prostate for benign prostatic hyperplasia: a systematic review and meta-analysis

Background: Benign prostatic hyperplasia (BPH) is a common urological condition in aging men, often requiring surgical intervention when medical therapy fails. The 1470-nm diode laser enucleation of the prostate (DiLEP) has emerged as a promising technique, but its efficacy and safety remain to be systematically evaluated. Methods: A systematic literature search was conducted in PubMed, Embase, Web of Science, and Cochrane Library to identify randomized controlled trials (RCTs) investigating 1470-nm DiLEP in the treatment of BPH. Primary outcomes included functional parameters such as International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), and post-void residual urine volume (PVR). Secondary outcomes included intraoperative and perioperative indicators (e.g., operative time, hemoglobin decrease, catheterization duration, bladder irrigation time) and complication rates. Effect sizes were synthesized using appropriate fixed- or random-effects models based on heterogeneity, and reported as mean difference (MD) or odds ratios with 95% confidence intervals. Results: Four RCTs involving 533 patients were included. 1470-nm DiLEP was associated with significantly shorter operative time (MD = −24.43, P < 0.0001), reduced hemoglobin loss (MD = −2.77, P = 0.02), shorter bladder irrigation time (MD = −13.23, P < 0.0001), and reduced catheterization duration (MD = −2.29, P < 0.0001). Functional outcomes such as IPSS, QoL, and Qmax were comparable between groups, but DiLEP showed superior reduction in PVR at 6 and 12 months. No significant differences in complication rates were observed. Conclusion: The 1470-nm DiLEP appears to be a safe and effective surgical option for BPH, with advantages in perioperative outcomes and potential mid-term functional benefits, particularly in improving bladder emptying. Further large-scale, long-term RCTs are needed to confirm these findings.