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Objective:To compare the holmium laser resection (HoLRBT) and transurethral resection of bladder tumur (TURBT) in the treatment of Non muscle-invasive bladder Cancer,To access the efficacy and safety of Holmium laser resection.Methods:We searched Pubmed, The Cochrane Library, CNKI,CVIP ;and hand searched the relevant Chinese urology surgery journals from 1993 to 2010.Randomized controlled trials(RCTs) were included. About 10712 Literatures were aquied,and 5 were included in RCTs.The quality of trials was evaluated and Meta-analysis was performed. Non-randomized controlled trials were also included to evaluate the safety and efficacy. The primary measures included operation time , hospital stay、the numbers of postoperative bladder perfusion and catheter time, the secondary measures were vesical perforation、nervus obturatorius reflex、urethral stricture complication rate and the third measures included postoperative tumor recurrences and the case number of obtaining tumor stages.Results:We found 5 randomized controlled trials. A total of 914 participants were in the trials.The Meta statistical showed as follow:difference between the two techniques in operation time{ Total WMD=-0.17,95﹪CI(-4.44,4.10),Z=0.08,P=0.94},Hospital stay{Total WMD=-2.17,95﹪CI(-2.47, -1.87),Z=14.34,P<0.00001}, the numbers of postoperative bladder perfusion{RR= 0.52,95﹪CI(0.33,0.81),Z=2.87,P=0.004}, Catheter time{Total WMD=-1.83, 95﹪CI(-2.18,-1.47),Z=10.16,P<0.0001}, vesical perforation in the follow-up 12 months {RR=0.10,95﹪CI(0.03,0.35), Z=3.62,P=0.0003}.The HoLRBT is more shorter in Hospital stay and Catheter time ,and fewer in the numbers of postoperative bladder perfusion.But there was no satistical difference between two techniques at 12 months follow-up in operation time. Vesical perforation {RR=0.10,95﹪CI(0.03,0.35), Z=3.62,P=0.0003}, nervus obturatorius reflex {RR=0.01,95﹪CI(0.00,0.13),Z=3.76, P=0.0002}, urethral stricture {RR=0.22,95﹪CI(0.03,1.36),Z=1.63, P=0.10 }, the case number of obtaining tumor stages.{RR=2.68,95﹪CI(2.27,3.18),Z=11.48,P < 0.00001}, postoperative tumor recurrences{RR=0.81,95﹪CI(0.61,1.07),Z=1.49, P=0.14 }. The HoLRBT is more lower in Vesical perforation、nervus obturatorius reflex complication rate and obtaining more number of tumor stages. But there was no satistical difference between two techniques at 12 months follow-up in urethral stricture and postoperative tumor recurrences.Coclusions:In short period HoLRBT and TURBT have no satistical difference in Operation time. The HoLRBT is more shorter in Hospital stay and Catheter time ,and fewer in the numbers of postoperative bladder perfusion. There was more lower in Vesical perforation、nervus obturatorius reflex complication rate and obtaining more number of tumor stages on HoLRBT at 12 months follow-up. But there was no satistical difference between two techniques at 12 months follow-up in urethral stricture and postoperative tumor recurrences.To treat Non muscle-invasive bladder Cancer by holmium laser as efficacy and safety as TURBT. But we need more randomized controlled trials and more follow-up time to study.
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